[1]庄渊钊但欣仪曾景阳江长城孙加晓**.术中不同水平氧浓度对冠心病患者腹腔镜手术后早期心肌损伤的影响：前瞻性随机对照研究[J].中国微创外科杂志,2025,01(7):393-397.
　Zhuang Yuanzhao,Dan Xinyi,Zeng Jingyang,et al.Effect of Different Intraoperative Oxygen Concentrations on Early Postoperative Myocardial Injury in Patients With Coronary Heart Disease Undergoing Laparoscopic Surgery:a Prospective Randomized Controlled Study[J].Chinese Journal of Minimally Invasive Surgery,2025,01(7):393-397.
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术中不同水平氧浓度对冠心病患者腹腔镜手术后早期心肌损伤的影响：前瞻性随机对照研究()
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《中国微创外科杂志》[ISSN:1009-6604/CN:11-4526/R]

卷:
01
期数:
2025年7期
页码:
393-397
栏目:
临床论著
出版日期:
2025-07-30

文章信息/Info

Title:
Effect of Different Intraoperative Oxygen Concentrations on Early Postoperative Myocardial Injury in Patients With Coronary Heart Disease Undergoing Laparoscopic Surgery:a Prospective Randomized Controlled Study
作者:
庄渊钊但欣仪曾景阳江长城孙加晓**
(福建医科大学附属泉州第一医院麻醉科，泉州362000)
Author(s):
Zhuang Yuanzhao;  Dan Xinyi;  Zeng Jingyang;  et al.
Department of Anesthesiology, Quanzhou First Hospital Affiliated to Fujian Medical University, Quanzhou 362000, China
关键词:
氧浓度; 冠心病; 腹腔镜手术; 心肌损伤
Keywords:
Oxygen concentration; Coronary heart disease; Laparoscopic surgery; Myocardial injury
文献标志码:
A
摘要:
目的探讨术中不同水平氧浓度对冠心病患者行腹腔镜手术后心肌损伤(myocardial injury after noncardiac surgery，MINS)的影响。方法选取2024年1~12月拟行腹腔镜手术的冠心病患者76例，随机分为L组(FiO2=0.3，n=39)和H组(FiO2=0.8，n=37)。L组若术中氧饱和度<92%则根据情况将FiO2增加0.03~0.1。将术后超敏肌钙蛋白T（hsTnT）>65 ng/L，或20 ng/L<65>5 ng/L定义为MINS。监测术前及术后4 h、12 h、24 h、48 h hsTnT、肌酸激酶MB(CKMB)同工酶水平，记录MINS发生率；记录术后7 d内新发主要心脑血管不良事件(major adverse cardiovascular and cerebrovascular event，MACCE)；记录出麻醉恢复室及术后12 h、24 h、48 h疼痛视觉模拟评分(Visual Analogue Scale，VAS)和镇痛药物补救情况。结果术后12 h、24 h的hsTnT水平L组明显低于H组(P<0.05)，术后12 h、24 h、48 h hsTnT较术前变化绝对值L组较H组小(P<0.05)。L组MINS发生率仅为H组的1/4［5.1%(2/39) vs. 21.6%(8/37)］，但差异无显著性(χ2=3.192，P=0.074)。2组术后7 d内MACCE发生率差异无显著性［0%(0/39) vs. 54%(2/37)，P=0.234］。2组术后48 h内疼痛评分及术后补救镇痛情况差异均无统计学意义(P>0.05)。结论冠心病患者行腹腔镜手术时，术中维持较低氧浓度(FiO2=0.3)可降低术后早期心肌损伤标志物升高的水平，有助于减少MINS。/html>
Abstract:
ObjectiveTo investigate the effect of different intraoperative oxygen concentrations on myocardial injury after noncardiac surgery (MINS) in patients with coronary heart disease undergoing laparoscopic surgery.MethodsA total of 76 patients with coronary heart disease scheduled for laparoscopic surgery between January and December 2024 were randomly assigned to group L (FiO2=0.3, n=39) or group H (FiO2=0.8, n=37). In the group L, if intraoperative oxygen saturation fell below 92%, FiO2 was increased incrementally by 0.03-0.1 as required. MINS was defined as postoperative highsensitivity troponin T (hsTnT) levels > 65 ng/L, or 20 ng/L < hsTnT < 65 ng/L with an absolute change from preoperative levels exceeding 5 ng/L. Levels of hsTnT and creatine kinase MB (CKMB) isoenzyme were monitored preoperatively and at 4, 12, 24, and 48 h postoperatively, and the incidence of MINS was recorded. The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) within 7 d postoperatively was documented. The Visual Analogue Scale (VAS) scores at 12, 24, and 48 h postoperatively, as well as rescue analgesic drug usage, were also recorded.ResultsPostoperative hsTnT levels at 12 and 24 h were significantly lower in the group L compared to the group H (P<0.05), and the absolute changes in hsTnT from preoperative levels at 12, 24, and 48 h were smaller in the group L than in the group H (P<0.05). The incidence of MINS in the group L was only onefourth that of the group H ［5.1% (2/39) vs. 21.6% (8/37)］, though this difference was not statistically significant (χ2=3.192, P=0.074). There was no significant difference in MACCE incidence within 7 d postoperatively between the two groups ［0% (0/39) vs. 5.4% (2/37), P=0234］. No statistically significant differences were observed in pain scores or rescue analgesia use within 48 h postoperatively between the groups (P>0.05).ConclusionMaintaining a lower intraoperative oxygen concentration (FiO2=0.3) in patients with coronary heart disease undergoing laparoscopic surgery reduces early postoperative myocardial injury markers and may help mitigate MINS.

参考文献/References:

[1]Jacka MJ,Youngson E,Bigam D,et al.Myocardial injury after noncardiac surgery in major general surgical patients a prospective observational cohort study.Ann Surg,2023,278(6):e1192-e1197.
[2]于雪,祖凌云,贾娜,等.老年患者非心脏手术围手术期心血管风险评估和管理的中国专家共识(2023).中国心血管杂志,2024,29(4):289-304.
[3]Park J,Lee JH.Myocardial injury in noncardiac surgery.Korean J Anesthesiol,2022,75(1):4-11.
[4]Bello C,Rssler J,Shehata P,et al.Perioperative strategies to reduce risk of myocardial injury after noncardiac surgery (MINS):a narrative review.J Clin Anesth,2023,87:111106.
[5]Acheampong A,Mélot C,Benjelloun M,et al.Effects of hyperoxia and cardiovascular risk factors on myocardial ischaemiareperfusion injury:a randomized,shamcontrolled parallel study.Exp Physiol,2021,106(5):1249-1262.
[6]刘文君,李红,林多茂,等.冠心病患者行非心脏手术围术期无创血压与有创血压测量的比较.心肺血管病杂志,2023,42(6):600-604.
[7]Gustafsson UO,Scott MJ,Hubner M,et al.Guidelines for perioperative care in elective colorectal surgery:Enhanced Recovery After Surgery (ERAS) Society recommendations 2018.World J Surg,2019,43(3):659-695.
[8]Joliat GR,Kobayashi K,Hasegawa K,et al.Guidelines for perioperative care for liver surgery:Enhanced Recovery After Surgery (ERAS) Society recommendations 2022.World J Surg,2023,47(1):11-34.
[9]Sadurni M,Castelltort L,Rivera P,et al.Perioperative hyperoxia and myocardial injury after surgery:a randomized controlled trial.Minerva Anestesiol,2023,89(1-2):40-47.
[10]Writing Committee for the VISION Study Investigators.Association of postoperative highsensitivity troponin levels with myocardial injury and 30day mortality among patients undergoing noncardiac surgery.JAMA,2017,317(16):1642-1651.
[11]Sousa J,RochaNeves J,OliveiraPinto J,et al.Myocardial injury after noncardiac surgery (MINS) in EVAR patients:a retrospective singlecentered study.J Cardiovasc Surg (Torino),2021,62(2):130-135.
[12]Botto F,AlonsoCoello P,Chan MT,et al.Myocardial injury after noncardiac surgery:a large,international,prospective cohort study establishing diagnostic criteria,characteristics,predictors,and 30day outcomes.Anesthesiology,2014,120(3):564-578.
[13]Mace EH,Kimlinger MJ,No TJ,et al.Soluble guanylyl cyclase activation rescues hyperoxiainduced dysfunction of vascular relaxation.Shock,2022,58(4):280-286.
[14]Thomas A,van Diepen S,Beekman R,et al.Oxygen supplementation and hyperoxia in critically ill cardiac patients:from pathophysiology to clinical practice.JACC Adv,2022,1(3):100065.
[15]姚文森,王永刚,刘全.肌钙蛋白与高敏肌钙蛋白在非冠心病患者中升高的鉴别诊断与预后价值.中国老年学杂志,2025,45(2):508-511.
[16]Ruetzler K,Cohen B,Leung S,et al.Supplemental intraoperative oxygen does not promote acute kidney injury or cardiovascular complications after noncardiac surgery:subanalysis of an alternating intervention trial.Anesth Analg,2020,130(4):933-940.
[17]Singer M,Young PJ,Laffey JG,et al.Dangers of hyperoxia.Crit Care,2021,25(1):440.

备注/Memo

备注/Memo:
基金项目：福建医科大学启航基金项目(2023QH1308)**通讯作者，Email：leonkillua@163.com
更新日期/Last Update: 2025-09-18