【罂粟摘要】非心脏手术全身麻醉期间吸入氧浓度比较：系统回顾和Meta分析

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非心脏手术全身麻醉期间吸入氧浓度比较：系统回顾和Meta分析

贵州医科大学    麻醉与心脏电生理课题组

翻译：严旭  编辑：潘志军  审校：曹莹

背景：关于接受全身麻醉的成人术中吸入氧浓度（FiO2）高和低的影响存在争议。本系统回顾和meta分析调查了高FiO2与低FiO2对术后结果的影响。

方法：2022年3月22日，对PubMed和Embase进行随机临床试验，调查不同FiO2水平对接受非心脏手术全身麻醉的成年人的影响。两名调查员独立审查了研究的相关性，提取了数据，并评估了偏见风险。对相关结果进行了meta分析，并在分组分析和meta回归中评估了潜在的效果测量修改。使用GRADE评估了证据确定性。

结果：本综述包括25项初步试验，调查高（大部分为80%）与低（大部分为30%）FiO2的影响。在所有试验中，偏见的风险都是中间的。高FiO2没有导致手术部位感染显著减少（OR：0.91，95%CI 0.81-1.02[p=0.10]）。没有发现对所有其他包括结果的影响，包括死亡率（OR=1.27,95%CI：0.90-1.79[p=0.18]）和住院时间（平均差异=0.03天，95%CI-0.25至0.30[p=0.84]）。分组分析和meta回归的结果没有识别出的明显效果。在大多数结果中，证据确定性（GRADE）被评为低。

结论：在接受非心脏手术全身麻醉的成年人中，高FiO2并不能改善手术部位感染、住院时间或死亡率等结果。然而，证据的确定性被评估为低。

原始文献来源：

Høybye, M., et al., Fraction of inspired oxygen during general anesthesia for non‐cardiac surgery: Systematic review and meta‐analysis. Acta Anaesthesiologica Scandinavica, 2022. 66(8): p. 923-933.

英文原文

Fraction of inspired oxygen during general anesthesia for non-cardiac surgery: Systematic review and meta-analysis

Abstract

Background: Controversy exists regarding the effects of a high versus a low intraoperative fraction of inspired oxygen (FiO2 ) in adults undergoing general anesthesia. This systematic review and meta-analysis investigated the effect of a high versus a low FiO2 on postoperative outcomes.

Methods: PubMed and Embase were searched on March 22, 2022 for randomized clinical trials investigating the effect of different FiO2 levels in adults undergoing general anesthesia for non-cardiac surgery. Two investigators independently reviewed studies for relevance, extracted data, and assessed risk of bias. Meta-analyses were performed for relevant outcomes, and potential effect measure modification was assessed in subgroup analyses and meta-regression. The evidence certainty was evaluated using GRADE.

Results: This review included 25 original trials investigating the effect of a high (mostly 80%) versus a low (mostly 30%) FiO2 . Risk of bias was intermediate for all trials. A high FiO2 did not result in a significant reduction in surgical site infections (OR: 0.91, 95% CI 0.81-1.02 [p = .10]). No effect was found for all other included outcomes, including mortality (OR = 1.27, 95% CI: 0.90-1.79 [p = .18]) and hospital length of stay (mean difference = 0.03 days, 95% CI -0.25 to 0.30 [p = .84). Results from subgroup analyses and meta-regression did not identify any clear effect modifiers across outcomes. The certainty of evidence (GRADE) was rated as low for most outcomes.

Conclusions: In adults undergoing general anesthesia for non-cardiac surgery, a high FiO2 did not improve outcomes including surgical site infections, length of stay, or mortality. However, the certainty of the evidence was assessed as low.

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