一个基于超声波的手术前方案,以优化流体治疗,以预防早期手术内低血压:一项随机对照研究
Marcell Szabó1, András Péter Pleck2, Sándor Árpád Soós3
1Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary. szabo.marcell@med.semmelweis-univ.hu.
Perioperative medicine (London, England)
|June 27, 2023
概括
一个基于超声波的液体治疗方案显著降低了主要腹部手术患者的手术内低血压. 这种护理点超声波方法为手术前流体管理提供了一种安全有效的方法,改善了患者的治疗结果.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 护理中心超声波检查
背景情况:
- 术后低血压是术后并发症的重要危险因素.
- 手术前脱水是手术内低血压的主要原因,但其严重程度很难估计.
- 护理点超声波 (POCUS) 提供了像下腔静脉 (IVC) 和肺超声波这样的方法来评估液体状况.
研究的目的:
- 评估基于超声波的术前流体治疗方案在降低早期手术内低血压的发生率方面的有效性.
- 评估POCUS是否可以指导流体管理,以预防手术期间的低血压.
主要方法:
- 一项随机对照研究,涉及选择性腹部主要手术患者 (ASA2-3),在全身麻醉下进行.
- 患者接受了传统的液体疗法或基于超声波的协议,评估IVC可折叠性和肺超声波资料.
- 超声波协议基于IVC可折叠性 (≥40%) 引导液体球体,并禁忌使用具有阳性肺B轮的进一步液体.
主要成果:
- 诱导后低血压的发生率在基于超声波的组 (7.9%) 与传统组 (31.6%) 相比显著较低 (p=0.0246).
- 使用低血压综合标准,超声组的病例比常规组 (44.7%) (p=0.0136) 少 (18.4%).
- 绝对低血压的危险比率在传统组 (2.10) 中较高,表明风险增加.
结论:
- 基于超声波的手术前液体替代方案是安全有效的.
- 该方案可以成功地应用于外科手术期间的护理,以减少手术内低血压.
- 超声指导改善了手术前的流体管理和潜在的患者结果.
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