目标导向血流动力学治疗对根治性膀胱切除术患者临床结局的影响：一项随机对照试验。

The effect of goal-directed hemodynamic therapy on clinical outcomes in patients undergoing radical cystectomy: a randomized controlled trial.

作者信息

Yoon Hyun-Kyu, Hur Min, Kim Dong Hyuk, Ku Ja Hyeon, Kim Jin-Tae

机构信息

Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.

Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehakro, Jongno-gu, Seoul, 03080, Korea.

出版信息

BMC Anesthesiol. 2023 Oct 9;23(1):339. doi: 10.1186/s12871-023-02285-9.

DOI:10.1186/s12871-023-02285-9

PMID:37814224

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10561433/

Abstract

BACKGROUND

This study investigated the effects of intraoperative goal-directed hemodynamic therapy (GDHT) on postoperative outcomes in patients undergoing open radical cystectomy.

METHODS

This prospective, single-center, randomized controlled trial included 82 patients scheduled for open radical cystectomy between September 2018 and November 2021. The GDHT group (n = 39) received the stroke volume index- and cardiac index-based hemodynamic management using advanced hemodynamic monitoring, while the control group (n = 36) received the standard care under the discretion of attending anesthesiologists during surgery. The primary outcome was the incidence of a composite of in-hospital postoperative complications during hospital stays.

RESULTS

A total of 75 patients were included in the final analysis. There was no significant difference in the incidence of in-hospital postoperative complications (28/39 [71.8%] vs. 30/36 [83.3%], risk difference [95% CI], -0.12 [-0.30 to 0.07], P = 0.359) between the groups. The amounts of intraoperative fluid administered were similar between the groups (2700 [2175-3250] vs. 2900 [1950-3700] ml, median difference [95% CI] -200 [-875 to 825], P = 0.714). The secondary outcomes, including the incidence of seven major postoperative complications, duration of hospital stay, duration of intensive care unit stay, and grade of complications, were comparable between the two groups. Trends in postoperative estimated glomerular filtration rate, serum creatinine, and C-reactive protein did not differ significantly between the two groups.

CONCLUSIONS

Intraoperative GDHT did not reduce the incidence of postoperative in-hospital complications during the hospital stay in patients who underwent open radical cystectomy.

TRIAL REGISTRATION

This study was registered at http://www.

CLINICALTRIALS

gov (Registration number: NCT03505112; date of registration: 23/04/2018).

摘要

背景

本研究调查了术中目标导向血流动力学治疗（GDHT）对接受开放性根治性膀胱切除术患者术后结局的影响。

方法

这项前瞻性、单中心、随机对照试验纳入了2018年9月至2021年11月期间计划接受开放性根治性膀胱切除术的82例患者。GDHT组（n = 39）使用先进的血流动力学监测，接受基于每搏量指数和心脏指数的血流动力学管理，而对照组（n = 36）在手术期间由主治麻醉师酌情给予标准护理。主要结局是住院期间术后并发症综合发生率。

结果

最终分析共纳入75例患者。两组间住院期间术后并发症发生率无显著差异（28/39 [71.8%] 对30/36 [83.3%]，风险差异[95%CI]，-0.12 [-0.30至0.07]，P = 0.359）。两组术中补液量相似（2700 [2175 - 3250] 对2900 [1950 - 3700] ml，中位数差异[95%CI] -200 [-875至825]，P = 0.714）。包括七种主要术后并发症发生率、住院时间、重症监护病房停留时间和并发症分级在内的次要结局在两组间具有可比性。两组术后估计肾小球滤过率、血清肌酐和C反应蛋白的变化趋势无显著差异。