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首页> 外文期刊>Anaesthesia and intensive care >Fluid administration, vasopressor use and patient outcomes in a group of high-risk cardiac surgical patients receiving postoperative goal-directed haemodynamic therapy: a pilot study
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Fluid administration, vasopressor use and patient outcomes in a group of high-risk cardiac surgical patients receiving postoperative goal-directed haemodynamic therapy: a pilot study

机译：一组接受术后目标导向血流动力学治疗的高危心脏外科手术患者的输液，升压药使用和患者预后：一项先导研究

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The role of goal-directed therapy in high-risk cardiac surgical patients has not been determined. This study sought to observe the effect of a postoperative standardised haemodynamic protocol (SHP) on the administration of fluid and vasoactive drugs after high-risk cardiac surgery. This was an interventional pilot study. In 2010 to 2011, the SHP was introduced to the ICU at Wellington Regional Hospital, Wellington, New Zealand, for the perioperative management of patients undergoing high-risk cardiac surgery. A pulmonary artery catheter was inserted in the patients in the study group and fluids and supportive medications were provided in the ICU according to a protocol that targeted a cardiac index >= 2 l/min/m(2), mixed venous oxygen saturation >= 60% and a mean arterial pressure of 65 to 75 mmHg. Data from 40 consecutive high-risk cardiac surgical patients assigned to this protocol were compared with a matched cohort of 40 consecutive high-risk cardiac surgical patients receiving 'usual care' in 2009. Baseline characteristics were similar in the two groups. There was no significant difference in the duration of noradrenaline infusion in the. SHP cohort compared to historical controls (median [IQR] 18.5 hours [31.63] versus 18 hours [18.3]; P=0.35), despite patients receiving more fluid in their first 12 hours in the ICU (mean 4687 ml [SD+/-2284 ml] versus 1889 ml [SD+/-1344 ml]; P<0.001). The SHP cohort had a higher rate of reintubation (4 in 37 [10.8%] versus 0 in 40 [0%]; P=0.049). The SHP delivered significantly more fluid, but did not reduce the duration of noradrenaline infusion, compared to usual care.
机译：目标治疗在高危心脏外科手术患者中的作用尚未确定。这项研究旨在观察术后高危心脏手术后标准化血流动力学协议（SHP）对输液和血管活性药物的影响。这是一项干预性试验研究。在2010年至2011年，SHP被引入新西兰惠灵顿惠灵顿地区医院的ICU中，用于接受高危心脏手术的患者的围手术期管理。在研究组的患者中插入了一条肺动脉导管，并根据针对心脏指数> = 2 l / min / m（2），混合静脉血氧饱和度> ==的方案在ICU中提供了输液和支持药物。 60％的平均动脉压为65至75毫米汞柱。将2009年分配给该方案的40名连续高危心脏外科手术患者的数据与2009年接受“常规护理”的40名连续高危心脏外科手术患者的匹配队列进行比较。两组的基线特征相似。去甲肾上腺素输注的持续时间没有显着差异。尽管患者在ICU的前12个小时接受了更多的补液（平均4687毫升[SD +/- 2284]，但SHP队列与历史对照组相比（中位[IQR] 18.5小时[31.63]对比18小时[18.3]; P = 0.35））毫升]对1889毫升[SD +/- 1344毫升]; P <0.001）。 SHP队列的再插管率更高（37例中有4例[10.8％]，而40例中有0例[0％]; P = 0.049）。与常规治疗相比，SHP输送的液体明显更多，但没有减少去甲肾上腺素的输注时间。

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