心力衰竭诊断准确性,手术内流体管理和术后急性损伤:一个单中心前性观察性研究
Michael R Mathis1, Kamrouz Ghadimi2, Andrew Benner3
1Department of Anesthesiology, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA; Department of Computational Bioinformatics, Michigan Medicine - University of Michigan, Ann Arbor, MI, USA.
British journal of anaesthesia
|October 10, 2024
概括
在非心脏手术之前准确地诊断心力衰竭,可以减少手术内流体和急性损伤. 改善心力衰竭的术前诊断可以改善患者的治疗结果.
科学领域:
- 心脏病学 心脏病学
- 麻醉学 麻醉学
- 腎臟病學 (nephrology) 是一種醫學專業.
背景情况:
- 在重大非心脏手术之前诊断心力衰竭 (HF) 存在重大挑战.
- 对HF的诊断准确度对手术内管理和患者结果的影响还不清楚.
研究的目的:
- 为了评估准确的手术前心力衰竭诊断和手术内液体的管理之间的关联.
- 确定准确的心力衰竭诊断和术后急性损伤 (AKI) 之间的关系.
主要方法:
- 一项观察性研究包括了2015年至2019年期间接受重大非心脏手术的成年患者.
- 一个医生小组通过医疗记录来判断心力衰竭的诊断,建立了一个参考标准.
- 术内液体体积和术后AKI分别是主要和次要结局.
主要成果:
- 准确的心力衰竭诊断与虚假阴性相比,与470毫升较少的手术内液体给药有关.
- 准确诊断心力衰竭的患者患术后急性损伤的风险显著降低 (aOR:0.39).
- 错误的阴性心力衰竭诊断在被保存的喷射分数和较少的并发症的患者中更为常见.
结论:
- 准确的术前心力衰竭诊断与术后结果的改善有关,包括减少液体的使用和较低的AKI率.
- 提高手术前心力衰竭诊断准确性的努力可能会导致非心脏手术中患者的治疗结果更好.
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