心脏外科的跨学科和跨部门的外科手术周围护理模型:在最小侵入性心脏门手术 (INCREASE) 的环境中实施ERAS - 随机对照试验的结果
Johannes Petersen1,2, Sina Stock3, Christian Brettschneider4
1Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
概括
手术后增强恢复 (ERAS) 协议对于微创心脏门手术 (MIHS) 是可行的和安全的. 虽然不减少住院时间,但需要进一步评估ERAS.
科学领域:
- 心脏病学 心脏病学
- 胸部外科手术 胸部外科手术
- 在外科手术期间的医学.
背景情况:
- 手术后增强恢复 (ERAS) 协议优化术后护理,旨在减少住院时间,并发症和成本,同时提高患者满意度.
- 在心脏手术,特别是微创心脏门手术 (MIHS) 中,ERAS的证据仍然有限.
研究的目的:
- 评估ERAS协议在接受微创心脏门手术 (MIHS) 的患者中的有效性和安全性.
- 评估ERAS对术后心血管相关住院和体力表现的影响.
主要方法:
- INCREASE试验是一项随机对照试验,将ERAS (干预组) 与MIHS患者的标准护理 (对照组) 进行比较.
- 同主终点包括在一年内住院的心血管住院和出院时的身体表现 (六分钟步行测试).
- 分析考虑了住院时间的优越性和身体表现的非劣势性.
主要成果:
- 总共有201名患者被随机分配. 在ERAS组的住院时间不显著缩短 (调整后平均差异 -2.7天).
- 敏感性分析有利于ERAS组住院 (调整后的比率为0.71).
- 六分钟步行测试的结果是可比的,在没有基线调整的情况下满足非劣质标准. 安全结果相似,除了ERAS组中术后心房的发病率较高.
结论:
- 对于接受轻微侵入性心脏门手术 (MIHS) 的患者,ERAS协议是可行的和安全的.
- 该研究没有达到其主要终点,即显著减少住院时间.
- 探索性发现表明,在这种外科患者群体中,对ERAS概念的持续调查是合理的.
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