Berlauk J F, Abrams J H, Gilmour I J, O'Connor S R, Knighton D R, Cerra F B
Department of Anesthesiology, University of Minnesota, Minneapolis 55455.
Ann Surg. 1991 Sep;214(3):289-97; discussion 298-9. doi: 10.1097/00000658-199109000-00011.
The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested. Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or the preinduction room (group 2) or to control (group 3). The tune-up consisted of fluid loading, afterload reduction, and/or inotropic support to achieve predetermined endpoints. Patients with a PA catheter had significantly fewer adverse intraoperative events (p less than 0.05), less postoperative cardiac morbidity (p less than 0.05), and less early graft thrombosis (p less than 0.05) than the control group. The overall study mortality rate was 3.4%, with a mortality rate of 9.5% in the control group and 1.5% in the PA catheter groups. There were no differences in ICU length of stay (LOS), hospital LOS, or total hospital costs, although the percentage of cost from complications was higher in group 3 (p greater than 0.05). In this group of patients, preoperative cardiac assessment and optimization is associated with improved outcome.
对使用肺动脉（PA）导管优化血流动力学（术前“调整”）能否改善肢体挽救性动脉手术患者预后的假设进行了检验。89例患者被随机分为三组，一组在外科重症监护病房（SICU）进行术前调整（第1组），一组在诱导前室进行术前调整（第2组），另一组为对照组（第3组）。调整包括液体负荷、降低后负荷和/或使用正性肌力药物支持以达到预定终点。与对照组相比，使用PA导管的患者术中不良事件显著减少（p<0.05），术后心脏发病率更低（p<0.05），早期移植物血栓形成更少（p<0.05）。总体研究死亡率为3.4%，对照组死亡率为9.5%，PA导管组死亡率为1.5%。重症监护病房住院时间（LOS）、住院LOS或总住院费用无差异，尽管第3组并发症费用所占百分比更高（p>0.05）。在这组患者中，术前心脏评估和优化与改善预后相关。
