人工关节置换术后低氧血症的发生机制与影响因素分析
Mechanisms and influencing factors of hypoxemia after joint arthroplasty
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.
更多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.
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