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首页> 外文期刊>Critical care : >Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study
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Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multi-center, prospective, randomized study

机译：基于radial动脉搏动压力变化和持续心脏指数趋势的围手术期目标血流动力学治疗可减少重大腹部手术后的术后并发症：一项多中心，前瞻性，随机研究

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IntroductionSeveral single-center studies and meta-analyses have shown that perioperative goal-directed therapy may significantly improve outcomes in general surgical patients. We hypothesized that using a treatment algorithm based on pulse pressure variation, cardiac index trending by radial artery pulse contour analysis, and mean arterial pressure in a study group (SG), would result in reduced complications, reduced length of hospital stay and quicker return of bowel movement postoperatively in abdominal surgical patients, when compared to a control group (CG).Methods160 patients undergoing elective major abdominal surgery were randomized to the SG (79 patients) or to the CG (81 patients). In the SG hemodynamic therapy was guided by pulse pressure variation, cardiac index trending and mean arterial pressure. In the CG hemodynamic therapy was performed at the discretion of the treating anesthesiologist. Outcome data were recorded up to 28 days postoperatively.ResultsThe total number of complications was significantly lower in the SG (72 vs. 52 complications, p = 0.038). In particular, infection complications were significantly reduced (SG: 13 vs. CG: 26 complications, p = 0.023). There were no significant differences between the two groups for return of bowel movement (SG: 3 vs. CG: 2 days postoperatively, p = 0.316), duration of post anesthesia care unit stay (SG: 180 vs. CG: 180 minutes, p = 0.516) or length of hospital stay (SG: 11 vs. CG: 10 days, p = 0.929).ConclusionsThis multi-center study demonstrates that hemodynamic goal-directed therapy using pulse pressure variation, cardiac index trending and mean arterial pressure as the key parameters leads to a decrease in postoperative complications in patients undergoing major abdominal surgery.Trial registrationClinicalTrial.gov, NCT01401283.
机译：引言多项单中心研究和荟萃分析表明，围手术期目标导向治疗可显着改善普通外科手术患者的预后。我们假设在研究组（SG）中使用基于脉搏压力变化，radial动脉脉搏轮廓分析得出的心脏指数趋势和平均动脉压的治疗算法，可以减少并发症，缩短住院时间并更快地恢复与对照组（CG）相比，腹部外科手术患者术后排便。方法将160例行选择性大腹部手术的患者随机分为SG（79例）或CG（81例）。在SG中，血流动力学治疗以脉搏压力变化，心脏指数趋势和平均动脉压为指导。在CG中，血流动力学治疗是由麻醉医生决定的。术后28天记录结果数据。结果SG的并发症总数明显减少（72例与52例，p = 0.038）。尤其是，感染并发症明显减少（SG：13 vs CG：26并发症，p = 0.023）。两组之间的肠蠕动恢复（SG：3 vs. CG：术后2天，p = 0.316），麻醉后护理时间（SG：180 vs. CG：180分钟，p）无显着差异。 = 0.516）或住院时间（SG：11 vs. CG：10天，p = 0.929）。结论这项多中心研究表明，以脉压变化，心脏指数趋势和平均动脉压为指标的血液动力学目标导向治疗关键参数可减少进行大腹部手术的患者术后并发症的发生率.ClinicalTrial.gov，NCT01401283。

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