经手术期间的pCO2差距可以预测接受重大选择性腹部手术的患者的并发症,随机分配到目标导向治疗或标准护理吗? 一个二次分析
Ilonka N de Keijzer1, Thomas Kaufmann2, Eric E C de Waal3
1Department of Anesthesiology, University Medical Center Groningen, University of Groningen, PO Box 30.001, 9700 RB, Groningen, The Netherlands. i.n.de.keijzer@umcg.nl.
Journal of clinical monitoring and computing
|January 22, 2024
概括
术前二氧化碳压力 (pCO2) 差距不是高风险腹部手术患者术后并发症的可靠预测指标. 这项研究发现,除了在手术结束时,没有并发症和没有并发症的患者之间的pCO2差距没有显著差异.
科学领域:
- 麻醉学和外科手术期间的医学.
- 手术结果研究研究.
- 关键护理医学 关键护理医学
背景情况:
- 二氧化碳压力 (pCO2) 差距,静脉和动脉pCO2之间的差异,被用作诊断和预后指标.
- 对于高风险的手术患者来说,评估术后pCO2差距对术后并发症的预测值至关重要.
研究的目的:
- 评估外科手术期间的二氧化碳压力 (pCO2) 差距是否可以预测高风险的选择性腹部手术患者的重大术后并发症.
- 为了比较pCO2差距作为目标导向疗法 (GDT) 和标准护理之间的预后工具的有效性.
主要方法:
- 一个多中心随机对照试验 (RCT) 的二次分析,涉及464名接受高风险选择性腹部手术的患者.
- 同时采集动脉和中静脉血液样本在四个外科手术时间点:诱导后,手术结束,PACU/ICU入院和PACU/ICU出院.
- 在30天内记录了术后并发症,并与pCO2差距测量相关联.
主要成果:
- pCO2差距不是术后并发症的重要预测指标,ROC曲线下的区域在0.5到0.6.之间.
- 在所有时间点 (ρ在 -0.40和 -0.29之间) 中央静脉氧和 (ScvO2) 和pCO2差距之间观察到具有统计学意义的但弱的负相关性.
- 在目标导向治疗 (GDT) 组和标准护理组之间,在任何时间点都没有发现pCO2差距的显著差异.
结论:
- 术前二氧化碳压力 (pCO2) 差距是高风险腹部手术后重大术后并发症的糟糕预测指标.
- 目前的证据不支持在这种患者群体中将pCO2差距作为预后工具的常规使用.
- 术后的pCO2差距在GDT和标准护理之间是可比的,这表明这些干预措施对这个生理参数没有不同的影响.
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