心脏手术患者的液体玻尿酸治疗后的生理变化:倾向性得分与病例对照研究相匹配
Martin Faltys1,2, Ary Serpa Neto3,4,5,6, Luca Cioccari1,7
1Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
概括
在心脏手术患者的液体玻尿酸治疗中,心脏输出量略有增加,但往往无法改善血液动力学. 这种常见的ICU干预不清楚生理影响,近一半的治疗缺乏显著的反应.
科学领域:
- 关键护理医学 关键护理医学
- 心血管生理学心血管生理学
- 外科手术的结果
背景情况:
- 液体玻尿酸治疗 (FBT) 是心脏手术后重症监护室 (ICU) 的标准治疗方法.
- 在这种患者群体中,FBT的确切生理影响尚不清楚.
研究的目的:
- 调查液体玻尿酸治疗 (FBT) 对心脏输出 (CO) 和心脏手术后ICU患者的平均动脉压 (MAP) 的生理影响.
- 为了将FBT后的血液动力学变化与没有液体的对照期进行比较.
主要方法:
- 一项准实验性研究使用来自第三级学术医院ICU的电子健康记录.
- 倾向性得分匹配被用来比较3572个液体玻尿酸发作与2,736名心脏手术患者的匹配对照发作.
- 在液体注射后60分钟内评估了CO和MAP的变化.
主要成果:
- 液体玻尿酸治疗与心脏输出量增加有关,虽然较小,但统计学上显著 (0.2L/分钟或40分钟以上基线的4%).
- 超过60%的FBT发作导致CO增加>10%,而对照组的~49% (p < 0.0001).
- 平均动脉压反应在FBT和对照组之间是相似的;FBT没有影响酸状态或氧气输送.
结论:
- 在心脏手术后的ICU患者中,液体玻尿酸治疗导致心脏输出量的适度增加.
- 显著比例的液体玻尿酸管理 (~50%) 没有取得显著的血液动力学改善 (CO或MAP>10%的增加).
- 这些小CO增加的临床意义需要进一步调查,考虑到频繁缺乏明显的反应.
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