流体管理与手术内血压之间的关联以及复杂的脊柱手术后患者的结果
Ye Rin Koh1, Yufei Li2,3, Joan Koh1
1From the Department of Anesthesiology, Cleveland Clinic, Cleveland, Ohio.
Anesthesia and analgesia
|December 17, 2024
概括
在复杂的脊椎手术期间过度注射液体会增加并发症的风险. 术内低血压也会增加术后不良结果的可能性,强调需要谨慎的流体管理.
科学领域:
- 麻醉学和外科手术期间的医学.
- 手术结果研究研究.
- 关键护理医学 关键护理医学
背景情况:
- 在手术期间的低血压和过度的液体摄入与不良的术后结果有关.
- 过多液体的精确值和低血压对重大术后并发症的影响仍然是研究领域.
研究的目的:
- 调查手术内净液体给药与手术后严重并发症的低血压之间的关系,在接受复杂脊柱手术的患者中.
- 为了确定与增加并发症风险相关的液体管理中的潜在变化点.
主要方法:
- 一个单一中心的回顾性队列研究包括6243名患者,他们在2012年至2022年期间接受了复杂的脊椎手术.
- 该研究分析了手术内净液体给药和低血压之间的关联,以及主要手术后并发症 (AKI,MI,中风,ICU入院) 的组合,以及肺部并发症,SSI和死亡率等二次结果.
主要成果:
- 在1865mL时,确定了净液体的变化点. 超过这一值的液体给药与术后并发症的几率增加了1.16倍 (P < .0001).
- 每增加500毫升的净流体管理在变化点以上增加并发症的几率 (OR 1.16),而低于它,几率下降 (OR 0.87).
- 术内低血压发生在29%的病例中,并与任何术后并发症的几率增加1.57倍相关 (P < .0001).
结论:
- 确定了1865毫升的净液体给药值,更高的体积增加了术后并发症的风险.
- 术内低血压是脊柱复杂手术后术后并发症增加的重要危险因素.
- 这些发现强调了在复杂的脊柱手术期间优化流体管理和监测低血压的重要性,以减轻不良结果.
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