麻醉后护理单元中的心脏手术快速通道治疗：莱比锡快速通道概念的六个月结果

Cardiac surgery fast-track treatment in a postanesthetic care unit: six-month results of the Leipzig fast-track concept.

作者信息

Ender Joerg, Borger Michael Andrew, Scholz Markus, Funkat Anne-Kathrin, Anwar Nadeem, Sommer Marcus, Mohr Friedrich Wilhelm, Fassl Jens

机构信息

Department of Cardiac Surgery, University of Leipzig, Leipzig Heart Center, Leipzig, Germany.

出版信息

Anesthesiology. 2008 Jul;109(1):61-6. doi: 10.1097/ALN.0b013e31817881b3.

DOI:10.1097/ALN.0b013e31817881b3

PMID:18580173

Abstract

BACKGROUND

The authors compared the safety and efficacy of a newly developed fast-track concept at their center, including implementation of a direct admission postanesthetic care unit, to standard perioperative management.

METHODS

All fast-track patients treated within the first 6 months of implementation of our direct admission postanesthetic care unit were matched via propensity scores and compared with a historical control group of patients who underwent cardiac surgery prior to fast-track implementation.

RESULTS

A total of 421 fast-track patients were matched successfully to 421 control patients. The two groups of patients had a similar age (64 +/- 13 vs. 64 +/- 12 yr for fast-track vs. control, P = 0.45) and European System for Cardiac Operative Risk Evaluation-predicted risk of mortality (4.8 +/- 6.1% vs. 4.6 +/- 5.1%, P = 0.97). Fast-track patients had significantly shorter times to extubation (75 min [45-110] vs. 900 min [600-1140]), as well as shorter lengths of stay in the postanesthetic or intensive care unit (4 h [3.0-5] vs. 20 h [16-25]), intermediate care unit (21 h [17-39] vs. 26 h [19-49]), and hospital (10 days [8-12] vs. 11 days [9-14]) (expressed as median and interquartile range, all P < 0.01). Fast-track patients also had a lower risk of postoperative low cardiac output syndrome (0.5% vs. 2.9%, P < 0.05) and mortality (0.5% vs. 3.3%, P < 0.01).

CONCLUSION

The Leipzig fast-track protocol is a safe and effective method to manage cardiac surgery patients after a variety of operations.

摘要

背景

作者将其中心新开发的快速康复理念（包括实施麻醉后护理单元直接收治）的安全性和有效性与标准围手术期管理进行了比较。

方法

在我们实施麻醉后护理单元直接收治的前6个月内接受治疗的所有快速康复患者通过倾向评分进行匹配，并与快速康复实施前接受心脏手术的历史对照组患者进行比较。

结果

总共421例快速康复患者成功匹配了421例对照患者。两组患者年龄相似（快速康复组与对照组分别为64±13岁和64±12岁，P = 0.45），欧洲心脏手术风险评估系统预测的死亡风险也相似（4.8±6.1%与4.6±5.1%，P = 0.97）。快速康复患者的拔管时间明显更短（75分钟[45 - 110]与900分钟[600 - 1140]），在麻醉后或重症监护病房的住院时间也更短（4小时[3.0 - 5]与20小时[16 - 25]）、中级护理病房（21小时[17 - 39]与26小时[19 - 49]）以及医院住院时间（10天[8 - 12]与11天[9 - 14]）（均表示为中位数和四分位间距，所有P < 0.01）。快速康复患者术后低心排血量综合征的风险也更低（0.5%与2.9%，P < 0.05），死亡率也更低（0.5%与3.3%，P < 0.01）。