在不同类型的外科手术中,外科期的目标导向治疗和术后并发症:更新的元分析
Mariateresa Giglio1, Giandomenico Biancofiore2, Alberto Corriero3
1Anesthesia and Intensive Care Unit, Policlinico di Bari, Piazza G. Cesare, 11, 70124, Bari, Italy. mariateresagiglio@gmail.com.
Journal of anesthesia, analgesia and critical care
|June 29, 2023
概括
目标导向疗法 (GDT) 减少了各种类型手术的术后并发症. 这项对52个RCT的元分析发现,GDT在主要腹部,骨科和神经外科手术中显著降低了并发症率.
科学领域:
- 麻醉学和重症监护医学
- 手术结果研究研究.
背景情况:
- 目标导向疗法 (GDT) 使用血液动力学监测优化组织输液,以指导液体和血管压缩剂的使用.
- 现有证据表明,GDT可以减少术后并发症,主要是在接受重大腹部手术的高风险患者中.
研究的目的:
- 评估术后GDT对各种手术过程中术后并发症的总体发生率的影响.
- 根据手术类型进行子组分析,以确定GDT的特定益处.
主要方法:
- 一项对52项随机对照试验 (RCT) 的系统分析,涉及6325名成年手术患者.
- 主要结局:至少有一个术后并发症的发生率. 按手术类型分析子组:主要的腹部,血管,骨科和神经外科手术.
- 使用几率比率 (OR) 和95%置信区间 (CI) 的元分析技术被采用.
主要成果:
- 经外科手术的GDT显著降低了整体并发症率 (OR 0.60;95% CI 0.49-0.72).
- 在重大腹部手术 (OR 0.72),骨科手术 (OR 0.53),神经外科手术 (OR 0.40) 中观察到并发症的显著减少.
- 在GDT中,流体和异能流体策略显示出显著的益处;GDT和对照组之间总流体体积没有显著差异.
结论:
- 在主要的腹部,骨科和神经外科手术中,GDT有效降低术后并发症率.
- 这些发现支持GDT在高风险患者和主要腹部手术之外的更广泛应用.
- 建议进一步进行精心设计的RCT,以探索GDT在更广泛的外科环境中的影响.
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