预防心脏外科手术患者脑损伤的心肺绕道过程中的高目标与低目标血压管理:随机对照试验
Anne G Vedel1, Frederik Holmgaard2, Lars S Rasmussen3
1Department of Cardiothoracic Anesthesia, The Heart Center (A.G.V., F.H., H.B.R., J.C.N.) ppci@vedel.dk.
Circulation
|January 18, 2018
概括
在心肺绕道术中向更高的平均动脉压并没有减少心脏手术患者的脑梗塞. 这项随机试验在高血压组和低血压组之间没有发现新的缺血病变的显著差异.
科学领域:
- 神经学
- 心脏病学
- 危急护理医学
背景情况:
- 脑损伤是心肺旁路手术后的一个严重并发症.
- 在50%的患者中,MRI检测到的无声性中风率为1-2%.
- 心肺旁路术期间的平均动脉压目标对脑梗塞的影响尚不清楚.
研究的目的:
- 调查心肺绕道术期间的高或低平均动脉压目标是否会影响心脏手术患者的脑梗塞发生率.
- 在不同平均动脉压目标之间比较新的缺血性脑病变的体积和数量.
主要方法:
- 一个患者和评估人员盲目的随机试验,涉及197名接受心脏手术的患者.
- 患者被分配到更高的 (70- 80毫米) 或更低的 (40- 50毫米) 平均动脉压目标,并用诺阿基因林定位.
- 使用扩散权重成像 (手术前和手术后) 来评估主要结果:新缺血性脑病变的总体积.
主要成果:
- 在低目标组的52. 8%和高目标组的55. 7%中检测到新的脑病变 (P=0. 76).
- 新脑病变的数量在各组之间是可比的 (估计差异中位数为0;P=0. 99).
- 在低目标和高目标组中,新的缺血病变的数量也相似 (差异估计中位数为0;P=0. 71).
结论:
- 在心肺旁路术期间,针对更高的平均动脉压并没有显著改变在心脏手术中的新脑梗塞的体积或数量.
- 这些发现表明,当前心肺旁路术的血压管理策略可能无法有效预防脑梗塞.
- 需要进一步的研究,以确定最佳的血压管理,以减少脑损伤.
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