目标导向的晶体化物与合物给药对术后螺旋计参数的影响:随机对照临床试验的副研究
Mina Obradovic1, Florian Luf1,2, Christian Reiterer1
1Department of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Spitalgasse 23, 1090, Vienna, Austria.
Perioperative medicine (London, England)
|April 15, 2024
概括
在主要腹部外科手术患者中,使用体的手术内目标导向液体管理与水晶体相比,没有改善术后的肺功能. 这两种流体策略都导致了手术后肺功能出现类似的损伤.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 外科手术的结果
背景情况:
- 大型腹部手术显著损害了手术后的肺功能.
- 限制性液体管理可以减轻这种损伤.
- 假设与水晶合物相比,合物具有节约液体的效果.
研究的目的:
- 为了测试手术中基于合体的目标导向液体管理策略是否会导致手术后肺功能障碍较小,而不是目标导向的晶类药物管理.
- 评估不同流体管理策略在重大腹部开放手术后对肺功能的影响.
主要方法:
- 一个预先计划的副研究,包括60名接受重大腹部开放手术的患者.
- 随机化以多普勒引导的液体替换为乳酸林格溶液 (晶体) 或6%的基乙烯粉 (合物).
- 床边螺旋计 (强迫生命能力,1秒内强迫呼气体积,峰值呼气流量) 在手术前和手术后6,24和48小时进行.
主要成果:
- 结晶体 (4567毫升) 的中位数手术内流体需求高于结合体 (3044毫升) (p = 0.01).
- 在术后6小时,在组之间没有观察到肺功能参数 (FVC,FEV1,PEF) 的显著差异.
- 纵向分析 (6-48小时) 对FVC,FEV1和PEF没有显著的时间 × 组相互作用.
结论:
- 目标导向的晶体和体的使用导致在接受重大开放腹部手术的患者中类似的术后肺功能参数受损.
- 在这项研究中,合体的节水效应并没有转化为改善肺功能结果.
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