在接受重大非心脏手术的患者中,个性化术后血压管理:双中心试点随机试验
Alina Bergholz1, Linda Grüßer2, Wiam T A K Khader2
1Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Journal of clinical anesthesia
|November 28, 2024
概括
使用夜间读数进行个性化血压管理对于重大手术是可行的. 这种方法的目标是预手术夜间水平以上的平均动脉压 (MAP),在未来的试验中有望减少器官损伤.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 外科手术患者管理
背景情况:
- 术后血压管理对于在重大非心脏手术期间预防器官损伤至关重要.
- 目前的策略通常使用固定值 (例如,MAP>65 mmHg),这可能对所有患者都不是最佳的.
研究的目的:
- 评估使用手术前夜平均动脉压 (MAP) 进行个性化外科手术期间血压管理的可行性.
- 确定在夜间MAP和固定65mmHg值之间具有临床意义的差异的患者比例.
- 评估维持在个性化夜间目标以上的手术内MAP的可行性.
主要方法:
- 双中心试点随机试验,涉及45岁或以上接受重大非心脏手术的患者.
- 术前自动化夜间血压监测,以建立个性化的MAP目标.
- 个性化的MAP目标与65mmHg的固定的手术内MAP目标的比较.
主要成果:
- 在93%的患者中,术前夜间血压监测是可行的.
- 在85%的患者中,在夜间MAP和65 mmHg之间观察到临床上有意义的差异 (> ±10 mmHg).
- 保持在个性化夜间目标以上的手术内MAP是可行的.
结论:
- 在接受重大非心脏手术的患者中,以手术前夜间MAP为指导的个性化外术期间血压管理是可行的.
- 这项试点研究支持了更大规模试验的可能性,以调查这种个性化方法对与 perfusion 相关的器官损伤的影响.
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