Bender J S, Smith-Meek M A, Jones C E
Department of Surgery, Johns Hopkins Bayview Medical Center and The Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
Ann Surg. 1997 Sep;226(3):229-36; discussion 236-7. doi: 10.1097/00000658-199709000-00002.
The authors determined whether the preoperative placement of a pulmonary artery catheter (PAC) with optimization of hemodynamics results in outcome improvement after elective vascular surgery.
The PAC commonly is used not only in patients who are critically ill, but also perioperatively in major elective surgery. Few prospective studies exist documenting its usefulness.
One hundred four consecutive patients were randomized to have a PAC placed the morning of operation (group I) or to have a PAC placed only if clinically indicated (group II). Group I patients were resuscitated to preestablished endpoints before surgery and kept at these points both intraoperatively and postoperatively. Group II patients received standard care.
There was one death in each group. An intraoperative or postoperative complication developed in 13 patients in group I versus 7 patients in group II (p = not significant). Group I patients received more fluid than did group II patients (5137 +/- 315 mL vs. 3789 +/- 306 mL; p < 0.003). There was no significant difference in either overall or surgical intensive care unit length of stay. Only one patient in group II required a postoperative PAC.
Routine PAC use in elective vascular surgery increases the volume of fluid given to patients without demonstrable improvement in morbidity or mortality.
作者确定术前放置肺动脉导管（PAC）并优化血流动力学是否能改善择期血管手术后的预后。
PAC不仅常用于危重病患者，也用于大型择期手术的围手术期。很少有前瞻性研究记录其效用。
104例连续患者被随机分为两组，一组在手术当天上午放置PAC（I组），另一组仅在临床需要时放置PAC（II组）。I组患者在手术前复苏至预设终点，并在术中和术后维持在这些指标。II组患者接受标准治疗。
每组各有1例死亡。I组有13例患者发生术中或术后并发症，II组有7例患者发生（p值无统计学意义）。I组患者比II组患者接受了更多的液体（5137±315毫升对3789±306毫升；p<0.003）。总体住院时间或外科重症监护病房住院时间无显著差异。II组只有1例患者术后需要放置PAC。
在择期血管手术中常规使用PAC会增加给予患者的液体量，而发病率或死亡率并无明显改善。
