在重大非心脏手术和术后神经认知障碍期间个性化血压管理:一项随机试验
Julia Y Nicklas1, Alina Bergholz1, Francesco Däke1
1Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
在主要非心脏手术患者中,个性化血压管理并没有减少术后神经认知障碍. 这种方法,维持平均动脉压 (MAP) 超过基线,与常规管理相比没有显著差异.
科学领域:
- 麻醉学 麻醉学
- 神经外科 神经外科
- 关键护理医学 关键护理医学
背景情况:
- 术后低血压和术后神经认知障碍 (PND) 之间的关系尚未完全理解.
- 这项研究调查了个性化血压管理是否可以在进行重大非心脏手术后减轻PND.
研究的目的:
- 测试个性化手术内血压管理与常规管理相比,可以降低PND发病率的假设.
- 为了评估维持高于手术前基线的平均动脉压 (MAP) 与固定值 (65 mm Hg) 的效果.
主要方法:
- 一个单中心随机试验,涉及328名接受选择性重大非心脏手术的患者.
- 患者被分配到个性化MAP管理 (在手术前基线以上) 或常规MAP管理 (在65毫米升以上).
- 主要结局是从术后第3天到第7天的神经认知障碍 (神经认知恢复延迟和妄想) 的发生率.
主要成果:
- 神经认知障碍发生在12%的个性化组和14%的常规组 (OR=0.84,P=0.622).
- 在这两组中,延迟神经认知恢复率为12% (OR=0.99,P=0.983).
- 妄想发病率在个性化组为1%,在常规组为3% (OR=0.50,P=0.684).
结论:
- 针对手术前基线MAP的个性化手术内血压管理并没有显著降低PND的发生率.
- 在个性化和常规管理组之间,在综合结果或其组件 (延迟神经认知恢复,妄想) 中没有发现显著差异.
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