评估低血压预测指数软件在接受正型肝移植的患者:回顾性观察性研究
Jacek B Cywinski1, Yufei Li2, Lusine Israelyan3
1Cleveland Clinic, Department of General Anesthesiology, Cleveland, Ohio; Cleveland Clinic, Department of Outcome Research, Cleveland, Ohio.
Brazilian journal of anesthesiology (Elsevier)
|January 24, 2025
概括
低血压预测指数 (HPI) 软件显示,在肝移植手术期间,肺动脉导管测量高级血液动力学参数的一致性较差. 虽然HPI对预测低血压很敏感,但其特异性较低,导致频繁的错误报警.
科学领域:
- 麻醉学和重症监护医学
- 外科手术血液动力学
- 移植手术 移植手术
背景情况:
- 术内低血压 (IOH) 是肝移植 (LT) 手术和早期康复期间经常出现的并发症.
- 低血压预测指数 (HPI) 软件为积极的血液动力学管理提供了潜力.
- 来自HPI的高级血液动力学参数 (心脏输出 - CO,全身血管阻力 - SVR) 的准确性及其在LT中的预测性能仍然未确立.
研究的目的:
- 评估HPI软件和肺动脉导管 (PAC) 之间的协议,用于在LT患者中测量CO和SVR.
- 评估HPI软件在LT手术中的手术内低血压的预测性能.
主要方法:
- 追溯观察性研究,涉及23名成年LT患者,使用PAC和HPI软件监测.
- 使用预定义的20%的相对差异,林的一致性相关系数和布兰德-阿尔特曼协议限制来评估协议.
- 通过计算灵敏度,正预测值 (PPV) 和警报到低血压事件 (MAP < 65 mmHg) 的时间来评估 HPI 的低血压预测能力.
主要成果:
- 只有42%的CO和53%的HPI的SVR记录与PAC测量结果相符.
- HPI显示高灵敏度 (0.96) 预测低血压,但低PPV (0.33),表明频繁的错误报警.
- 从HPI警报到低血压事件的中位时间为3.3分钟.
结论:
- 在LT患者的高级血液动力学参数 (CO,SVR) 中,HPI软件和PAC之间缺乏一致性.
- HPI软件对低血压预测具有高灵敏度,但特异性较低,导致虚假报警的负担很大.
- 由于准确性和特异性问题,HPI在LT手术中进行主动血液动力学管理的临床实用性需要进一步调查.
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