Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
J Clin Monit Comput. 2022 Dec;36(6):1775-1783. doi: 10.1007/s10877-022-00826-0. Epub 2022 Feb 24.
Acute myocardial injury is common after noncardiac surgery and associated with mortality. Impaired intraoperative cardiovascular dynamics are a risk factor for acute myocardial injury. Optimizing intraoperative cardiovascular dynamics may thus reduce acute myocardial injury. We aimed to investigate the effect of intraoperative personalized goal-directed hemodynamic management on the incidence of acute myocardial injury. We hypothesized that personalized goal-directed hemodynamic management reduces the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. We performed a post-hoc secondary analysis of a randomized clinical trial including 180 high-risk major abdominal surgery patients that were randomized to personalized goal-directed hemodynamic management or routine hemodynamic management. We compared the incidences of acute myocardial injury-defined according to the Fourth Universal Definition of Myocardial Infarction (2018)-between patients randomized to personalized goal-directed hemodynamic management or routine hemodynamic management by calculating the relative and absolute risk reduction together with 95% Wald confidence intervals and P values. Acute myocardial injury occurred in 4 of 90 patients (4%) in the personalized goal-directed hemodynamic management group and in 12 of 90 patients (13%) in the routine hemodynamic management group (relative risk: 0.33, 95% confidence interval: 0.11 to 0.99, P = 0.036; absolute risk reduction: - 9%, 95% confidence interval: - 17% to - 0.68%, P = 0.034). In this post-hoc secondary analysis, intraoperative personalized goal-directed hemodynamic management reduced the incidence of acute myocardial injury compared to routine hemodynamic management in high-risk patients having major abdominal surgery. This needs to be confirmed in larger prospective trials.
急性心肌损伤是心脏外手术后的常见并发症，并与死亡率相关。术中心血管动力学受损是急性心肌损伤的危险因素。因此，优化术中心血管动力学可能会降低急性心肌损伤的发生率。我们旨在研究术中个体化目标导向的血流动力学管理对急性心肌损伤发生率的影响。我们假设与常规血流动力学管理相比，个体化目标导向的血流动力学管理可降低高危行大腹部手术患者的急性心肌损伤发生率。我们对一项随机临床试验进行了事后二次分析，该试验纳入了 180 例高危大腹部手术患者，这些患者被随机分配至个体化目标导向的血流动力学管理组或常规血流动力学管理组。我们通过计算相对风险和绝对风险降低率，以及 95% Wald 置信区间和 P 值，比较了随机分配至个体化目标导向的血流动力学管理组或常规血流动力学管理组的患者中急性心肌损伤的发生率（根据 2018 年第四版心肌梗死通用定义定义）。个体化目标导向的血流动力学管理组 90 例患者中有 4 例（4%）发生急性心肌损伤，常规血流动力学管理组 90 例患者中有 12 例（13%）发生急性心肌损伤（相对风险：0.33，95%置信区间：0.11 至 0.99，P=0.036；绝对风险降低率：-9%，95%置信区间：-17% 至-0.68%，P=0.034）。在这项事后二次分析中，与常规血流动力学管理相比，高危行大腹部手术患者的术中个体化目标导向的血流动力学管理可降低急性心肌损伤的发生率。这需要在更大的前瞻性试验中得到证实。
