在手术单位对急性损伤的决策支持的阶段性试验
Matthew T James1,2,3,4, Elijah Dixon2,5, Zhi Tan1
1Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
Kidney international reports
|October 21, 2024
概括
临床决策支持并没有改善手术患者急性损伤 (AKI) 管理. 干预措施未能减少AKI的进展,透析或死亡,突显了需要替代策略的需要.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 急性损伤 (AKI) 是术前期经常出现的并发症,导致患者的不良后果.
- 临床决策支持系统 (CDSS) 在改善手术环境中的AKI早期管理和结果方面的有效性尚不清楚.
研究的目的:
- 评估教育和CDSS干预对手术患者AKI早期管理和结果的影响.
- 评估干预措施是否可以减少AKI的进展,透析的需要或死亡率.
主要方法:
- 一个集群随机化,阶梯试验,涉及加拿大阿尔伯塔省的8个外科病房.
- 单位被随机分配到分阶段实施教育和CDSS干预,用于AKI识别和管理.
- 包括在外科病房中患有AKI的18岁以上的患者,但不包括已经接受透析的患者.
主要成果:
- 综合初级结局 (AKI进展,透析或死亡) 发生在干预组的16.0%,对照组的17.5% (OR,0.76;95% CI,0.53-1.08;P=0.12),没有统计学意义.
- 在AKI发作后48小时内,关键的护理过程结果没有显著差异,包括液体给药或药物调整.
- 在AKI后住院的时间和3个月后估计的淋巴细胞过率 (eGFR) 恢复在各组之间是相似的.
结论:
- 实施的教育和CDSS干预措施并没有显著改善手术单位对AKI患者的护理流程.
- 干预措施没有导致AKI进展的减少,住院时间的减少,或改善功能恢复.
- 需要进一步的研究来确定有效的策略来管理手术患者群体中的AKI.
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