一期 Norwood 姑息术后血流动力学状态的时间依赖性风险识别。
Identification of Time-Dependent Risks of Hemodynamic States After Stage 1 Norwood Palliation.
机构信息
Herma Heart Institute, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin; Cincinnati Children's Medical Center, Cincinnati, Ohio; Texas Children's Hospital, Houston, Texas.
Herma Heart Institute, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, Wisconsin; Cincinnati Children's Medical Center, Cincinnati, Ohio; Texas Children's Hospital, Houston, Texas.
出版信息
Ann Thorac Surg. 2020 Jan;109(1):155-162. doi: 10.1016/j.athoracsur.2019.06.063. Epub 2019 Aug 9.
BACKGROUND
Mortality after stage 1 palliation of hypoplastic left heart syndrome remains significant. Hemodynamic changes result from interaction of cardiac output (CO) and systemic vascular resistance (SVR). We sought to identify time-dependent changes in postoperative hemodynamic states and their associations with mortality.
METHODS
Perioperative data were prospectively collected in an institutional review board-approved database. Hemodynamic state was classified as high CO, high SVR, low SVR, and low CO using bivariate analysis of mean arterial pressure and somatic regional near-infrared spectroscopic oximetry saturation. State classifications over 48 postoperative hours were modelled using multinomial logistic regressions for association with mortality.
RESULTS
Data from 9614 of 10,272 hours in 214 patients were analyzed. Operative survival was 91%. The predominant state was high CO (46% time). Low CO state without extracorporeal membrane oxygenation (ECMO) was found in 52% of patients for 9.7% time. ECMO was employed in 24 (11.2%) patients for 10.4% time. State stability was 33%, with high SVR the least stable (17%) and high CO the most stable (53%). Transition from high CO increased in hours 1 to 12, mainly to low SVR. Transition to low CO was 18.4%, increasing in hours 1 to 12, mainly from high SVR. The transition risk to ECMO was 0.32%, and 0.74% during hours 1 to 12, only from low CO. Both low CO and ECMO had increased mortality risk.
CONCLUSIONS
Bivariate classification defines hemodynamic states with distinct physiologic, transition, and mortality risk profiles. High SVR state was unstable. Transition to ECMO occurred only from low CO, while the low SVR and high CO states were safest.
背景
左心发育不全综合征 1 期姑息术后死亡率仍然很高。心输出量（CO）和全身血管阻力（SVR）的相互作用导致血流动力学变化。我们试图确定术后血流动力学状态的时间依赖性变化及其与死亡率的关系。
方法
在机构审查委员会批准的数据库中前瞻性收集围手术期数据。使用平均动脉压和躯体区域近红外光谱血氧饱和度的双变量分析，将血流动力学状态分类为高 CO、高 SVR、低 SVR 和低 CO。使用多项逻辑回归模型对术后 48 小时内的状态分类进行建模，以分析其与死亡率的关系。
结果
对 214 例患者的 10272 小时中的 9614 小时的数据进行了分析。手术存活率为 91%。主要状态是高 CO（46%的时间）。未使用体外膜肺氧合（ECMO）的低 CO 状态在 52%的患者中持续 9.7%的时间。24 例（11.2%）患者使用 ECMO 持续 10.4%的时间。状态稳定性为 33%，其中高 SVR 最不稳定（17%），高 CO 最稳定（53%）。从高 CO 到低 SVR 的转变在 1 至 12 小时内增加，主要是从高 SVR 到低 SVR 的转变。从高 CO 到低 CO 的转变发生率为 18.4%，在 1 至 12 小时内逐渐增加，主要是从高 SVR 到低 CO 的转变。发生 ECMO 的转换风险为 0.32%，在 1 至 12 小时内为 0.74%，仅从低 CO 发生。低 CO 和 ECMO 均有增加死亡率的风险。
结论
双变量分类定义了具有不同生理、转变和死亡率风险特征的血流动力学状态。高 SVR 状态不稳定。只有从低 CO 才会发生向 ECMO 的转变，而低 SVR 和高 CO 状态是最安全的。
Zotero 插件