Veelo Denise P, van Berge Henegouwen Mark I, Ouwehand Kirsten S, Geerts Bart F, Anderegg Maarten C J, van Dieren Susan, Preckel Benedikt, Binnekade Jan M, Gisbertz Suzanne S, Hollmann Markus W
Department of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
PLoS One. 2017 Mar 2;12(3):e0172806. doi: 10.1371/journal.pone.0172806. eCollection 2017.
Goal-directed therapy (GDT) can reduce postoperative complications in high-risk surgery patients. It is uncertain whether GDT has the same benefits in patients undergoing esophageal surgery. Goal of this Quality Improvement study was to evaluate the effects of a stroke volume guided GDT on post-operative outcome.
We compared the postoperative outcome of patients undergoing esophagectomy before (99 patients) and after (100 patients) implementation of GDT. There was no difference in the proportion of patients with a complication (56% vs. 54%, p = 0.82), hospital stay and mortality. The incidence of prolonged ICU stay (>48 hours) was reduced (28% vs. 12, p = .005) in patients treated with GDT. Secondary analysis of complication rate showed a decrease in pneumonia (29 vs. 15%, p = .02), mediastinal abscesses (12 vs. 3%, p = .02), and gastric tube necrosis (5% vs. 0%, p = .03) in patients treated with GDT. Patients in the GDT group received significantly less fluids but received more colloids.
The implementation of GDT during esophagectomy was not associated with reductions in overall morbidity, mortality and hospital length of stay. However, we observed a decrease in pneumonia, mediastinal abscesses, gastric tube necrosis, and ICU length of stay.
目标导向治疗（GDT）可降低高危手术患者的术后并发症。目前尚不确定GDT在接受食管手术的患者中是否具有同样的益处。这项质量改进研究的目的是评估每搏量导向的GDT对术后结局的影响。
我们比较了实施GDT之前（99例患者）和之后（100例患者）接受食管切除术患者的术后结局。并发症患者比例（56%对54%，p = 0.82）、住院时间和死亡率无差异。接受GDT治疗的患者延长重症监护病房（ICU）住院时间（>48小时）的发生率降低（28%对12%，p = 0.005）。并发症发生率的二次分析显示，接受GDT治疗的患者肺炎（29%对15%，p = 0.02）、纵隔脓肿（12%对3%，p = 0.02）和胃管坏死（5%对0%，p = 0.03）有所减少。GDT组患者接受的液体显著减少，但接受的胶体更多。
食管切除术中实施GDT与总体发病率、死亡率和住院时间的降低无关。然而，我们观察到肺炎、纵隔脓肿、胃管坏死和ICU住院时间有所减少。
