Department of Emergency Medicine, Ishikawa Prefectural Central Hospital, 2-1, Kuratsuki higashi, Kanazawa, 920-8530, Japan.
Department of Health Data Science, Graduate School of Data Science, Yokohama City University, 22-2, Seto, Kanazawa, Yokohama, 236-0027, Japan.
Heart Vessels. 2024 Jan;39(1):57-64. doi: 10.1007/s00380-023-02306-0. Epub 2023 Aug 18.
Although intraoperative intravenous fluids are commonly administered to reverse intraoperative hypotension during cardiac surgery, the appropriate volume remains unclear. This study aimed to evaluate the relationship between the intraoperative fluid balance and sequential organ failure assessment (SOFA) score in patients undergoing cardiac surgery to determine the impact of intraoperative intravenous fluids on their organs. This was a post hoc analysis using data from a multicenter, retrospective, observational study across 14 intensive care units (ICUs) in Japan. Adult patients admitted to ICUs after elective coronary artery bypass grafting or valve surgery from January 1 to December 31, 2018 were enrolled. We compared patients with intraoperative fluid balance < 20 ml/kg to those with fluid balance ≥ 20 ml/kg and conducted a multiple regression analysis for the SOFA score within 24 h of ICU admission. Of the 1567 included patients, 870 met the eligibility criteria. A total of 725 patients (83%) had an intraoperative fluid balance of ≥ 20 ml/kg. In the univariate analysis, the SOFA score (interquartile range) was 7 (6-8) and 7 (6-9) in the intraoperative fluid balance < 20 ml/kg and ≥ 20 ml/kg groups, respectively (p = 0.017). Multiple regression analysis showed a positive association between intraoperative fluid balance and SOFA score within 24 h of ICU admission [standardized coefficient 0.0065 (95% confidence interval 0.0036-0.0095), p < 0.001]. Intraoperative fluid balance in patients undergoing cardiac surgery was significantly associated with higher SOFA scores within 24 h of ICU admission.
尽管在心脏手术期间常通过静脉内输液来纠正术中低血压，但合适的输液量仍不清楚。本研究旨在评估心脏手术患者术中液体平衡与序贯器官衰竭评估（SOFA）评分之间的关系，以确定术中静脉输液对其器官的影响。这是一项在日本 14 个重症监护病房（ICU）进行的多中心、回顾性、观察性研究的数据的事后分析。纳入 2018 年 1 月 1 日至 12 月 31 日择期行冠状动脉旁路移植术或瓣膜手术并入住 ICU 的成年患者。我们比较了术中液体平衡＜20 ml/kg 的患者与液体平衡≥20 ml/kg 的患者，并对 ICU 入院后 24 小时内的 SOFA 评分进行了多元回归分析。在纳入的 1567 例患者中，870 例符合入选标准。共有 725 例患者（83%）术中液体平衡≥20 ml/kg。在单变量分析中，SOFA 评分（四分位间距）分别为术中液体平衡＜20 ml/kg 组和≥20 ml/kg 组的 7（6-8）和 7（6-9）（p=0.017）。多元回归分析显示，ICU 入院后 24 小时内术中液体平衡与 SOFA 评分呈正相关[标准化系数 0.0065（95%置信区间 0.0036-0.0095），p＜0.001]。心脏手术患者术中液体平衡与 ICU 入院后 24 小时内 SOFA 评分升高显著相关。
