心脏手术正常血压期间低心脏指数的发生:使用连续无创心排血量监测的前瞻性队列研究。

IF 4.6 2区 医学 Q1 ANESTHESIOLOGY
Anesthesia and analgesia Pub Date : 2025-01-01 Epub Date: 2024-12-16 DOI:10.1213/ANE.0000000000007206
Lee A Goeddel, Lily Koffman, Marina Hernandez, Glenn Whitman, Chirag R Parikh, Joao A C Lima, Karen Bandeen-Roche, Xinkai Zhou, John Muschelli, Ciprian Crainiceanu, Nauder Faraday, Charles Brown
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引用次数: 0

摘要

背景:尽管患者面临全身灌注不足的巨大风险,但连续心输出量监测并不是心脏手术的标准做法。因此,心脏手术中出现低心输出量的频率尚不清楚:我们于 2021 年 7 月至 2023 年 11 月在一家三级医疗中心开展了一项前瞻性队列研究。符合条件的患者年龄≥18 岁,正在接受使用心肺旁路(CPB)的孤立冠状动脉旁路(CAB)手术。在整个手术过程中,使用美国食品和药物管理局(FDA)批准的无创监护仪从动脉血压波形中以 5 秒钟的间隔连续记录心输出量与体表面积(CI)的指数。同时还分析了平均动脉血压 (MAP) 和中心静脉压 (CVP)。结果:共分析了 101 名患者(年龄 [标准差,SD] 64.8 [9.8] 岁,25% 为女性)。低CI的术中总时间(平均值[标度])为86.4(62)分钟,其中CPB前低CI为61.2(42)分钟,CPB后为25.2(31)分钟。低 CI 和正常 MAP 的术中总时间为 66.5 (56) 分钟,占低 CI 总时间的 69% (23%);CPB 前为 45.8 (38) 分钟,CPB 后为 20.6 (27) 分钟。总体而言,CI 与 MAP 之间的相关性(平均值 [SD])为 0.33 (0.31),CPB 前(0.53 [0.32])的相关性显著高于 CPB 后(0.29 [0.28],95% 置信区间 [CI] 差异 [0.18-0.34],P < .001);但是,CPB 前后 CI 与 MAP 的相关性在参与者之间存在很大的异质性。考虑到 CVP 的二次分析并未改变 CI 与 MAP 之间的相关性。探索性分析提示了低 CI 的持续时间(C 结论:在接受 CAB 手术的前瞻性队列患者中,即使血压正常,低 CI 也很常见。CI 与 MAP 的相关性不大。CPB 前的相关性高于 CPB 后,但个体间存在很大的异质性。今后还需要进行研究,探讨低 CI 与术后肾损伤及其他与低灌注相关的不良后果之间的独立关系。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Occurrence of Low Cardiac Index During Normotensive Periods in Cardiac Surgery: A Prospective Cohort Study Using Continuous Noninvasive Cardiac Output Monitoring.

Background: Continuous cardiac output monitoring is not standard practice during cardiac surgery, even though patients are at substantial risk for systemic hypoperfusion. Thus, the frequency of low cardiac output during cardiac surgery is unknown.

Methods: We conducted a prospective cohort study at a tertiary medical center from July 2021 to November 2023. Eligible patients were ≥18 undergoing isolated coronary bypass (CAB) surgery with the use of cardiopulmonary bypass (CPB). Cardiac output indexed to body surface area (CI) was continuously recorded at 5-second intervals throughout surgery using a US Food and Drug Administration (FDA)-approved noninvasive monitor from the arterial blood pressure waveform. Mean arterial blood pressure (MAP) and central venous pressure (CVP) were also analyzed. Low CI was defined as <2 L/min/m 2 and low MAP as <65 mm Hg. We calculated time with low CI for each patient for the entire surgery, pre-CPB and post-CPB periods, and the proportion of time with low CI and normal MAP. We used Pearson correlation to evaluate the relationship between CI and MAP and paired Wilcoxon rank sum tests to assess the difference in correlations of CI with MAP before and after CPB.

Results: In total, 101 patients were analyzed (age [standard deviation, SD] 64.8 [9.8] years, 25% female). Total intraoperative time (mean [SD]) with low CI was 86.4 (62) minutes, with 61.2 (42) minutes of low CI pre-CPB and 25.2 (31) minutes post-CPB. Total intraoperative time with low CI and normal MAP was 66.5 (56) minutes, representing mean (SD) 69% (23%) of the total time with low CI; 45.8 (38) minutes occurred pre-CPB and 20.6 (27) minutes occurred post-CPB. Overall, the correlation (mean [SD]) between CI and MAP was 0.33 (0.31), and the correlation was significantly higher pre-CPB (0.53 [0.32]) than post-CPB (0.29 [0.28], 95% confidence interval [CI] for difference [0.18-0.34], P < .001); however, there was substantial heterogeneity among participants in correlations of CI with MAP before and after CPB. Secondary analyses that accounted for CVP did not alter the correlation between CI and MAP. Exploratory analyses suggested duration of low CI (C <2 L/min/m 2 ) was associated with increased risk of postoperative acute kidney injury (odds ratios [ORs] = 1.09; 95% CI; 1.01-1.13; P = .018).

Conclusions: In a prospective cohort of patients undergoing CAB surgery, low CI was common even when blood pressure was normal. CI and MAP were correlated modestly. Correlation was higher before than after CPB with substantial heterogeneity among individuals. Future studies are needed to examine the independent relation of low CI to postoperative kidney injury and other adverse outcomes related to hypoperfusion.

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来源期刊
Anesthesia and analgesia
Anesthesia and analgesia 医学-麻醉学
CiteScore
9.90
自引率
7.00%
发文量
817
审稿时长
2 months
期刊介绍: Anesthesia & Analgesia exists for the benefit of patients under the care of health care professionals engaged in the disciplines broadly related to anesthesiology, perioperative medicine, critical care medicine, and pain medicine. The Journal furthers the care of these patients by reporting the fundamental advances in the science of these clinical disciplines and by documenting the clinical, laboratory, and administrative advances that guide therapy. Anesthesia & Analgesia seeks a balance between definitive clinical and management investigations and outstanding basic scientific reports. The Journal welcomes original manuscripts containing rigorous design and analysis, even if unusual in their approach.
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