低氧气输送与心肺绕道和长期死亡率增加的关联
Milo Engoren1, David Sturmer2, Donald S Likosky3
1Department of Anesthesiology, University of Michigan, Ann Arbor, Michigan.
心肺旁路术期间较低的氧气输送与长期死亡率的增加有关. 红细胞输血没有改变这种关联,突出显示了足够的氧气供应 (DO2I) 对患者生存的重要性.
科学领域:
- 心血管外科心血管外科
- 腎臟病學 (nephrology) 是一種醫學專業.
- 临界护理医学 临界护理医学
背景情况:
- 减少氧气输送与急性损伤有关.
- 氧气输送和长期死亡率之间的关联尚未得到充分理解.
- 输血对这种关联的修改效应需要进一步研究.
研究的目的:
- 调查指数为身体表面积 (DO2I) 的氧气输送与长期死亡率之间的关联.
- 为了确定红细胞输血是否会改变DO2I和死亡率之间的关系.
主要方法:
- 追溯性研究分析了每分钟的流量和血红蛋白数据.
- 计算心肺绕道过程中指数为身体表面积 (DO2I) 的平均和累积氧气输送量.
- 利用考克斯的比例和非比例危险模型来评估与长期死亡率的关联.
主要成果:
- 死亡的患者的DO2I平均值显著降低,累计DO2I缺陷更大.
- 经过多种因素的调整后,平均DO2I和累积DO2I赤字都与死亡率有关.
- 累积的DO2I赤字成为死亡率的更强有力的预测因素,独立于红细胞输血状态.
结论:
- 降低的DO2I,无论是以平均或累积赤字来衡量,与长期死亡率相反相关.
- 红细胞输血并没有显著改变DO2I和死亡率之间的关系.
- 在心肺绕道术期间保持足够的氧气输送对于改善患者长期结果至关重要.
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