在心肺绕道术期间氧气供应不足导致心脏手术后的炎症反应
Enrico Squiccimarro1,2, Roberto Lorusso2,3, Giuseppe Boccaforno4
1Division of Cardiac Surgery, Department of Medical and Surgical Sciences, University of Foggia, Foggia, 71122, Italy.
概括
心肺绕道 (CPB) 期间的低指数氧气输送 (DO2i) 与系统性炎症反应综合征 (SIRS) 和不良结果的风险增加有关. 优化DO2i可能会减少CPB后的并发症.
科学领域:
- 心血管外科心血管外科
- 关键护理医学 关键护理医学
- 败血症研究 败血症研究
背景情况:
- 系统性炎症反应综合征 (SIRS) 是心肺绕道术 (CPB) 后的常见和严重并发症.
- 在CPB之后的SIRS与较高的死亡率和较差的患者结局有关.
- 了解预测SIRS的因素对于改善心脏手术后的患者护理至关重要.
研究的目的:
- 调查CPB期间索引氧气输送 (DO2i) 与SIRS发展之间的关联.
- 确定DO2i的潜在值,从而预测SIRS和不良结果.
- 探索SIRS在DO2i和临床结果之间的关系中扮演的调解角色.
主要方法:
- 在两个机构进行了前性观察性研究.
- 在CPB期间测量了指数化氧输送 (DO2i),手术后12小时评估了SIRS.
- 多变量后勤回归,倾向得分匹配和结构方程建模用于分析.
主要成果:
- 在DO2i和SIRS之间发现了一个显著的反向关联 (aOR为0.798每+10毫升/分钟/米2).
- 确定DO2i值≤293mL/min/m2可以预测SIRS.
- 较低的DO2i与较高的SIRS发病率,不良综合结果相关,并介导了46.2%对结果的影响.
结论:
- 在CPB期间的低指数氧气输送是SIRS和随后不良临床结果的重要预测因素.
- 这些发现表明,旨在优化DO2i的目标导向输液策略需要在随机试验中进一步调查,以减轻炎症并改善结果.
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