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在腹腔大动脉手术中以低血压预测指数为指导的手术内血液动力学管理:Hemas多中心观察研究

Enrico Giustiniano¹, Fulvio Nisi^2,3, Federica Ferrod⁴

¹Department of Anesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.

Journal of anesthesia, analgesia and critical care

|February 13, 2025

概括

这项研究表明,使用带有低血压预测指数 (HPI) 的血液动力学管理算法,在开放腹腔大动脉瘤修复期间有效降低了手术内低血压,改善了患者的治疗结果.

科学领域:

麻醉学和重症监护医学
心血管外科心血管外科
医疗技术和设备医疗技术和设备

背景情况:

术内低血压 (IOH) 与术后并发症的增加有关,特别是在重大血管手术期间.
对IOH的预测算法对于改善外科手术结果至关重要.
开放腹腔大动脉动脉瘤修复具有低血压事件的高风险.

研究的目的:

为了研究一种包含低血压预测指数 (HPI) 的血液动力学管理算法的有效性,在开放腹腔大动脉瘤修复过程中减少IOH.
评估HemosphereTM平台对尽量减少低血压发作及其严重性的影响.
评估算法限制手术内低血压的发生率和持续时间的能力.

主要方法:

一项多中心观察性研究招募了53名接受选择性腹腔大动脉动脉瘤修复的患者.
使用Acumen-HPI HemosphereTM平台实施了一个血液动力学协议,包括HPI,Ea-dyn和dP/dt参数.
主要终点是累积的手术内低血压时间<10%的外科手术时间;次要终点包括低血压事件的发生率和时间加权平均平均平均动脉压 (MAP) <65 mmHg (TWA65) 和<50 mmHg (TWA50).

主要成果:

主要终点成功实现,手术内低血压时间<10%的手术时间记录在5% [1-10%].
达到了MAP<65 mmHg (TWA65) 和<50 mmHg (TWA50) 的目标时间加权平均值,TWA65 = 0.26 [0.04-0.65] mmHg和TWA50 = 0.00 [0.00-0.01] mmHg.
该算法在限制手术内低血压的发生率和严重程度方面取得了成功.

结论:

实施的血液动力学管理算法,以HPI和HemosphereTM平台为指导,在开放腹腔大动脉修复过程中有效地限制了手术内低血压.
这种方法有望减轻高风险手术过程中术后并发症的重大风险因素.
该研究支持使用预测性血液动力学监测来优化复杂手术期间的患者护理.

关键词:

腹部主动脉的腹部主动脉血液动力学监测血液动力学监测在手术期间的低血压.开放性大动脉修复这是血管外科手术.

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