实施心脏手术ERAS协议后的结果
Tomi Obafemi1, Danielle Mullis1, Simar Bajaj1
1Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, United States of America.
PloS one
|July 14, 2023
概括
斯坦福医院的手术后增强恢复 (ERAS) 协议减少了患者的发病率和心脏手术停留时间. 这些基于证据的协议也改善了接受开放性大动脉手术的重症患者的死亡率.
科学领域:
- 心脏外科手术 心脏外科手术
- 在外科手术期间的护理.
- 基于证据的医学基于证据的医学.
背景情况:
- 适当的术后护理对于心脏手术成功的结果至关重要.
- 手术后增强恢复 (ERAS) 协议代表了向基于证据的术前管理的转变.
研究的目的:
- 评估实施ERAS协议对斯坦福医院心脏手术后患者结果的影响.
- 评估ERAS实施后死亡率,发病率和停留时间的变化.
主要方法:
- 单一中心,回顾性分析比较ERAS实施前和后的队列.
- 对 CABG / 门和开放性大动脉手术进行倾向性得分匹配分析.
- 关键的终点包括30天死亡率,发病率 (VAP,UTI),总LOS,ICU LOS,以及输出管/导管切除的时间.
主要成果:
- 在CABG/门手术中实施ERAS减少了中位数的术后LOS和ICU LOS,显著降低了VAP和UTI发病率.
- 开放性大动脉手术显示改善了30天死亡率,降低了ICU LOS,并减少了机械通风持续时间.
- 虽然观察到一些趋势,但对所有次要终点的统计学意义在开放性大动脉手术中没有达到.
结论:
- 斯坦福医院的ERAS途径成功降低了心脏手术患者的发病率和停留时间.
- 实施ERAS协议导致了重症患者死亡率的提高.
- 基于证据的ERAS协议在优化术后护理和复杂心脏手术中的患者结果方面是有效的.
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