在腹部手术中以低血压预测指数为指导的血液动力学管理:多中心随机临床试验
Javier Ripollés-Melchor1, José L Tomé-Roca2, Andrés Zorrilla-Vaca3
1Infanta Leonor University Hospital, Madrid, Spain; Universidad Complutense de Madrid, Madrid, Spain; Fluid Therapy and Hemodynamic Monitoring, Spanish Society of Anesthesia and Critical Care, Madrid, Spain.
Anesthesiology
|January 2, 2025
概括
低血压预测指数 (HPI) 导向治疗在重大腹部手术后没有显著减少中度至重度急性损伤 (AKI). 与标准护理相比,这种方法并没有降低整体并发症或其他不良结果.
科学领域:
- 麻醉学和外科手术期间的医学.
- 腎臟病學 (nephrology) 是一種醫學專業.
- 关键护理医学 关键护理医学
背景情况:
- 手术后急性损伤 (AKI) 是主要腹部手术后的重大并发症,与患者的不良结果有关.
- 低血压预测指数 (HPI) 是一种旨在帮助管理手术内血动力学不稳定的工具.
- 这项研究研究了HPI指导治疗在预防高风险手术患者中中度至重度AKI的疗效.
研究的目的:
- 评估低血压预测指数 (HPI) 引导的血液动力学管理是否能降低接受选择性腹部大手术的患者中度至重度AKI的发生率.
- 为了比较HPI指导治疗和标准护理之间的整体并发症,替代疗法,住院时间和30天死亡率.
主要方法:
- 一个多中心随机试验,涉及917名患者 (≥65岁或ASA身体状况>II) 接受中度至高风险的选择性腹部手术.
- 患者被分配到HPI指导管理 (当HPI>80时引发的干预) 或标准血液动力学护理.
- 主要终点是术后7天内中度至重度AKI的发生率.
主要成果:
- 在HPI组中,中度至重度AKI的发病率为6.1%,在标准治疗组中为7.0% (风险比0.89,P=0.66).
- 在整体并发症 (31.9%对29.7%),替代疗法,住院或30天死亡率方面,两组之间没有发现显著差异.
- 患者的中位年龄为70-71岁,超过57%的患者被分类为ASA身体状况III/IV.
结论:
- 与标准护理相比,HPI指导的血液动力学治疗没有显著减少术后AKI的发生率.
- 该研究发现,HPI指导的管理对整体并发症或其他次要结果没有显著的益处.
- 目前的证据表明,HPI指导疗法在这个手术患者群体中预防AKI并不优于标准护理.
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