在心脏外科手术中使用肺动脉导管中的实践模式变化
Emily J MacKay1, Bo Zhang2, Joseph M Beaty3
1Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; Penn's Cardiovascular Outcomes, Quality and Evaluative Research Center, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA.
Journal of cardiothoracic and vascular anesthesia
|September 7, 2025
概括
在心脏手术期间使用肺动脉导管 (PAC) 是常见的,在72%的手术中使用监测. 医院实践模式,而不是个体麻醉师的决定,最显著地影响了PAC利用率.
科学领域:
- 心血管外科心血管外科
- 麻醉学 麻醉学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术内肺动脉导管 (PAC) 监测是心脏外科手术中的关键工具.
- 在不同的机构和提供者之间,PAC利用率存在差异.
研究的目的:
- 量化心脏手术期间内科PACs的使用情况.
- 确定影响医院,麻醉师和患者使用PAC的因素.
主要方法:
- 使用通用后勤混合模型进行横截面的观察性研究.
- 分析了来自53家美国学术医院 (2016-2022) 的145,343次成人心脏手术数据.
- 使用中位数赔率比率 (MOR) 进行变化的表征.
主要成果:
- 72%的心脏手术 (104,626/145,343) 需要进行手术内PAC监测.
- 根据医院 (0-98%) 和麻醉师 (0-100%) 的情况,PAC的使用率有很大差异.
- 医院实践模式 (MOR=15.00) 是PAC使用的最强预测因素,超过麻醉师水平变化 (MOR=1.70).
结论:
- 在美国学术中心,在约72%的心脏手术中使用了手术期间的PAC监测.
- 医院一级的实践差异是PAC利用差异的主要驱动因素.
- 基于证据的PAC使用标准化可能会提高心脏手术护理的一致性.
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