在接受心肺旁路辅助心脏手术的患者中,限制性与自由氧化:一种随机对照试验
Sebastian Wiberg1, Christian H Møller2, Jesper Kjaergaard3
1Department of Cardiothoracic Anesthesiology and Intensive Care, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
在心肺绕道 (CPB) 期间,限制性 (50% FiO2) 与自由 (100% FiO2) 氧化对心脏手术患者的重大不良事件没有显著影响. 死亡,中风,功能衰竭和心力衰竭等结果在各组之间是相似的.
科学领域:
- 心脏病学 心脏病学
- 关键护理医学 关键护理医学
- 麻醉学 麻醉学
背景情况:
- 在心肺绕道 (CPB) 期间保持足够的氧气输送在心脏手术中至关重要.
- 在CPB期间的过氧 (过量的氧气) 可能导致器官损伤.
- 在CPB期间和之后的最佳氧化策略仍在研究中.
研究的目的:
- 为了比较限制性与自由性氧化策略在CPB和断奶期间的临床结果.
- 评估不同氧化水平对心脏手术患者主要不良事件的影响.
主要方法:
- 一个单一的中心,患者和评估者盲目的随机试验.
- 接受CPB辅助冠状动脉旁路移植或大动脉置换的成年人被分配给限制性 (50% FiO2) 或自由 (100% FiO2) 氧疗法.
- 主要综合结局包括死亡时间,中风,需要透析的功能衰竭或新发病/恶化的心力衰竭.
主要成果:
- 包括1389名参与者 (平均年龄67岁).
- 限制性氧化 (50% FiO2) 在CPB期间导致Pao2水平中位数为19-23kPa.
- 在限制性 (24%) 和自由性 (24%) 氧化组 (HR,1.01;P=0.92) 之间,在5.9年的中位随访期内,没有观察到主要复合结果的显著差异.
结论:
- 限制性氧化 (50% FiO2) 和自由氧化 (100% FiO2) 策略产生了类似的死亡率,中风,透析依赖性功能衰竭和心力衰竭.
- 两种策略都没有在CPB辅助心脏手术期间或之后预防重大不良事件方面显著的优势.
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