一项临床方案的随机对照可行性试验,用于在重大非心脏手术期间管理低血压
D N Wijeysundera1,2, D Duncan2,3, J Moreno Garijo2,4
1Department of Anesthesia, St. Michael's Hospital, Toronto, ON, Canada.
Anaesthesia
|November 8, 2023
概括
这项研究发现,使用微创监视器来管理手术内低血压的新方案是可行的. 该方案减少了液体平衡和低血压暴露,为更大规模的试验铺平了道路.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
背景情况:
- 在手术期间的低血压带来了术后并发症和死亡的重大风险.
- 最少侵入性血液动力学监测为改善低血压管理提供了潜力.
- 动脉波形分析提供了先进的血液动力学见解.
研究的目的:
- 评估在手术后低血压治疗方案的可行性和可接受性,以微创血液动力学监测为指导.
- 评估该协议对血压管理,护理流程和患者结果的影响.
- 为未来多中心随机对照试验的设计提供信息.
主要方法:
- 一个单中心可行性试验,涉及年龄≥40岁,患有心血管风险因素的成年人,接受非心脏手术.
- 随机分配到通常的护理或以动脉波形轮分析为指导的协议.
- 盲目参与者,结果评估者,临床医生和分析师对治疗分配.
主要成果:
- 33%的同意率和成功招募60名参与者 (每组30人).
- 麻醉提供者发现该方案可行和可接受.
- 协议组表现出流体平衡降低和较少暴露于低血压.
- 术后并发症包括急性心肌损伤 (30%),急性损伤 (28%) 和手术部位感染 (12%).
结论:
- 这项研究证实了一项多中心试验的可行性,该试验调查了手术内低血压的生理学指导治疗方案.
- 最少侵入性血液动力学监测指导的协议显示,有望改善外科手术期间的护理.
- 需要进一步的研究来确定这种方法在更大的人群中的有效性和安全性.
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