Dietrich Maximilian, Hölle Tobias, Piredda Mattia, Feißt Manuel, Rehn Patrick, von der Forst Maik, Fischer Dania, Hackert Thilo, Larmann Jan, Michalski Christoph W, Weigand Markus A, Loos Martin, Schmitt Felix C F
Medical Faculty Heidelberg, Department of Anesthesiology, Heidelberg University, Heidelberg, Germany.
Department of Anesthesiology, Heidelberg University Hospital, Im Neuenheimer Feld 420, 69120, Heidelberg, Germany.
Langenbecks Arch Surg. 2025 Apr 8;410(1):123. doi: 10.1007/s00423-025-03669-w.
Optimization of perioperative hemodynamic management during major pancreatic surgery can reduce postoperative complications.
In this study, we aimed to investigate the effect of intraoperative hemodynamic management, in consideration of both anesthesiologic and surgery-related aspects on major short-term complications following partial pancreatoduodenectomy (PD).
DESIGN, SETTING AND PARTICIPANTS: Data of 525 patients undergoing PD between January 2017 and December 2018 at the Heidelberg University Hospital were retrospectively analyzed.
Primary outcome was a composite of 90-day mortality, pancreatic fistula and completion pancreatectomy. Logistic regression was performed to estimate the impact of anesthesiologic and surgical factors. Furthermore, patients were stratified by the amount of fluid administered intraoperatively and the maximum catecholamine dose to examine the impact on the primary endpoint.
Using logistic regression analysis we demonstrated that epidural anesthesia was associated with a reduction in the occurrence of the combined endpoint (OR 0.568; CI 0.331-0.973), this effect was primarily driven by a lower rate of completion pancreatectomy. The intraoperative administration of fresh frozen plasma (FFP) doubled the odds of the occurrence of the primary endpoint (OR 2.238; CI 1.290-3.882). The comparison of patients with and without FFP transfusion showed that all components of the primary endpoint were more frequent in the FFP group. Complication rates in the stratified fluid groups showed a U-shaped curve with the least amount of complications in patients who received 6.5 to 8 ml/kg/h of intraoperative fluid. The comparison of maximum norepinephrine doses revealed the same pattern with the least complication rate in the low-intermediate dose range (0.05-0.08 µg/kg/min and 0.08-0.11 µg/kg/min).
Epidural anesthesia had a beneficial effect on the rate of major surgical complications following PD, whereas intraoperative FFP transfusion showed a negative association. Intraoperative hemodynamic management appears to have a major impact on perioperative mortality and morbidity with a U-shaped relation for both fluid and vasopressor dose.
在大型胰腺手术期间优化围手术期血流动力学管理可减少术后并发症。
在本研究中，我们旨在探讨术中血流动力学管理，同时考虑麻醉学和手术相关方面对胰十二指肠切除术（PD）后主要短期并发症的影响。
设计、设置和参与者：回顾性分析了2017年1月至2018年12月在海德堡大学医院接受PD手术的525例患者的数据。
主要结局是90天死亡率、胰瘘和全胰切除术的综合指标。进行逻辑回归以评估麻醉学和手术因素的影响。此外，根据术中补液量和最大儿茶酚胺剂量对患者进行分层，以检查对主要终点的影响。
使用逻辑回归分析，我们证明硬膜外麻醉与联合终点发生率的降低相关（OR 0.568；CI 0.331 - 0.973），这种效果主要由较低的全胰切除术发生率驱动。术中输注新鲜冰冻血浆（FFP）使主要终点发生的几率增加了一倍（OR 2.238；CI 1.290 - 3.882）。有FFP输血和无FFP输血患者的比较表明，FFP组主要终点的所有组成部分都更频繁出现。分层液体组中的并发症发生率呈U形曲线，术中补液量为6.5至8 ml/kg/h的患者并发症最少。最大去甲肾上腺素剂量的比较显示出相同的模式，在低 - 中剂量范围（0.05 - 0.08 μg/kg/min和0.08 - 0.11 μg/kg/min）并发症发生率最低。
硬膜外麻醉对PD术后主要手术并发症发生率有有益影响，而术中FFP输血显示出负相关。术中血流动力学管理似乎对围手术期死亡率和发病率有重大影响，液体和血管升压药剂量均呈U形关系。
