CAJ | 학술논문

目的分析人工关节置换术后低氧血症的发生规律、临床特点及影响因素.方法对2013年1至5月北京中日友好医院骨关节外科接受人工关节置换术的135例患者围手术期脉搏血氧饱和度(SpO2)测定,并进行曲线描记,比较不同性别、年龄、身高体重指数(BMI)、血型、疾病诊断、麻醉方式、手术类型、手术医师、抗凝方式、血红蛋白变化(ΔHG)、血细胞比容变化(ΔHCT)、血小板变化(ΔPLT)等对术后低氧状态的影响,以及对低氧血症的预测价值.结果单因素分析显示,性别、年龄、疾病诊断、麻醉方式及手术类型与人工关节置换术后低氧血症状态有关.多元线性回归分析结果表明,年龄对人工关节置换术后低氧血症的形成具有一定的预测意义(单侧手术:B为0.080,S.E为0.016,P=0.000;双侧手术:B为0.074,S.E为0.025,P=0.006).结论人工关节置换术后SpO2的变化有一定的规律,术后2 d内容易发生无症状性低氧血症,尤以全膝关节置换术为著,而年龄是人工关节置换术后低氧血症的影响因素,对高龄患者,围手术期及时给予干预措施,预防致命性并发症的发生.
목적 분석인공관절치환술후저양혈증적발생규률、림상특점급영향인소.방법 대2013년1지5월북경중일우호의원골관절외과접수인공관절치환술적135례환자위수술기맥박혈양포화도(SpO2)측정,병진행곡선묘기,비교불동성별、년령、신고체중지수(BMI)、혈형、질병진단、마취방식、수술류형、수술의사、항응방식、혈홍단백변화(ΔHG)、혈세포비용변화(ΔHCT)、혈소판변화(ΔPLT)등대술후저양상태적영향,이급대저양혈증적예측개치.결과 단인소분석현시,성별、년령、질병진단、마취방식급수술류형여인공관절치환술후저양혈증상태유관.다원선성회귀분석결과표명,년령대인공관절치환술후저양혈증적형성구유일정적예측의의(단측수술:B위0.080,S.E위0.016,P=0.000;쌍측수술:B위0.074,S.E위0.025,P=0.006).결론 인공관절치환술후SpO2적변화유일정적규률,술후2 d내용역발생무증상성저양혈증,우이전슬관절치환술위저,이년령시인공관절치환술후저양혈증적영향인소,대고령환자,위수술기급시급여간예조시,예방치명성병발증적발생.
Objective To explore the mechanisms and influencing factors of hypoxemia after joint arthroplasty to further guide and improve clinical management. Methods From January 2013 to May 2013, 135 patients undergoing joint arthroplasty were retrospectively analyzed. Perioperative pulse oximetry (SpO2) were measured and plotted. The effects of gender, age, body mass index (BMI), blood group, disease diagnosis, anesthesia, type of surgery, surgeon, anticoagulation method, hemoglobin changes (ΔHG), hematocrit changes (ΔHCT) and platelet changes (ΔPLT) on the postoperative hypoxemia and their predictive values were analyzed. Results Univariate analysis showed that hypoxemia were associated with gender, age, diagnosis, type of surgery and anesthesia(P<0.05). And multivariate linear regression analysis revealed that age was independently associated with postoperative hypoxemia. ConclusionPerioperative SpO2 changes have certain patterns. Asymptomatic hypoxemia is likely to occur within two days, especially during knee arthroplasty. As an independent factor, age impacts the incidence of hypoxemia after primary joint arthroplasty. For elderly patients, we should strengthen timely interventions for preventing life-threatening complications.