国家指导方针对手术后热素监测的影响:回顾性队列研究
Eva Alvarez Torres1, Justyna Bartoszko1,2, Selene Martinez Perez1
1Department of Anesthesiology and Pain Management, Toronto General Hospital, University Health Network Toronto, Toronto, ON, Canada.
Canadian journal of anaesthesia = Journal canadien d'anesthesie
|November 16, 2023
概括
2017年加拿大心血管学会 (CCS) 的指导方针略微增加了非心脏手术后的托罗邦监测. 然而,这并没有显著改变心肌梗塞 (MI) 或住院死亡率.
科学领域:
- 心脏病学 心脏病学
- 在外科手术期间的医学.
- 临床指南 临床指南
背景情况:
- 在非心脏手术后检测肌肉心脏损伤时,托罗宁监测至关重要.
- 2017年加拿大心血管学会 (CCS) 的指导方针旨在标准化托洛的使用.
- 评估指南对临床实践的影响对于质量改进至关重要.
研究的目的:
- 评估2017年CCS指导方针对非心脏手术后激素检测频率的影响.
- 确定指南的实施是否影响了心肌梗塞 (MI) 或死亡率.
- 分析与患者心血管并发症相关的热素监测模式的变化.
主要方法:
- 一项追溯的观察性研究,对36386名40岁以上的患者进行了中高风险的非心脏手术.
- 在CCS指南发布之前 (2016-2018) 和之后 (2019-2021) 的托罗邦尼检测率的比较.
- 对心肌损伤,心肌梗塞和住院死亡率结果的分析,以基线差异进行调整.
主要成果:
- 在指导方针发布后,托罗邦的监测略有增加,从13%增加到14% (OR 1.08;95% CI 1.02-1.15)
- 在指南后期,对托罗邦监测的调整几率更高 (OR 1.14;95% CI 1.07-1.21),尽管并发病率较低.
- 心脏病发作率 (0.3%与0.2%) 和死亡率 (0.5%与0.4%) 并没有显著变化.
结论:
- 2017年CCS指导方针导致非心脏手术后的热素订购量略有增加.
- 尽管加强了监测,但这些指南并没有显著影响心脏病发作或患者死亡率的检测.
- 可能需要进一步的研究,以优化在外科手术期间使用热素.
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