通过输液来优化中风体积的手术内目标定向的血液动力学疗法:随机对照试验的元分析
J Ripollés-Melchor1, Á V Espinosa2, P Fernández-Valdes-Bango3
1Department of Anesthesia, Infanta Leonor University Hospital, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring Group of the Spanish Society of Anesthesiology and Critical Care, Madrid, Spain.
Revista espanola de anestesiologia y reanimacion
|September 7, 2024
概括
使用液体给药以优化中风体积 (SV) 的目标定向血液动力学疗法 (GDHT) 并没有减少主要腹部手术患者的术后并发症或死亡率. 然而,它与较短的逗留时间有关.
科学领域:
- 麻醉学和外科手术期间的医学.
- 临界护理医学 临界护理医学
- 手术结果研究研究
背景情况:
- 在重大腹部手术中,液体的使用至关重要.
- 目标导向的血液动力学疗法 (GDHT) 旨在优化循环功能.
- 优化中风体积 (SV) 是GDHT的一个关键组成部分.
研究的目的:
- 评估通过在目标导向血液动力学疗法 (GDHT) 中通过液体管理优化中风体积 (SV) 的临床影响.
- 评估GDHT对术后并发症,急性损伤 (AKI),停留时间 (LOS) 和成年患者接受选择性腹部大手术的死亡率的影响.
主要方法:
- 系统审查和对29项遵循PRISMA指南的随机对照试验 (RCT) 的元分析.
- 干预:通过流体挑战或动态指数优化SV的手术内GDHT与通常的流体管理相比.
- 主要结局:术后并发症;次要结局:AKI,LOS,手术内液体给药,30天死亡率.
主要成果:
- 在术后并发症 (RR 0.89),AKI (OR 0.97) 或死亡率 (OR 0.80) 中没有发现显著差异.
- GDHT与逗留时间缩短有关 (SMD: -0.17).
- 在GDHT中使用基乙烯粉与更少的并发症相关 (RR 0.79),而晶类增加了风险 (RR 1.08).
结论:
- 在GDHT中以液体为基础的中风体积优化并没有减少大手术后的患病率或死亡率.
- 选择的液体 (基乙烯粉与晶体) 可能会影响并发症的发生率.
- 可能需要进一步的研究来澄清特定流体策略在GDHT中的作用.
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