围手术期目标导向的人工智能治疗减少肺手术患者术中低血压和肾功能衰竭的发生率：一项试点研究

IF 5 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-02-14 DOI:10.1016/j.jclinane.2025.111777

Marit Habicher MD , Sara Marie Denn MD , Emmanuel Schneck MD , Amir Ali Akbari MD , Götz Schmidt MD , Melanie Markmann PhD , Ibrahim Alkoudmani MD , Christian Koch MD , Michael Sander MD

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引用次数: 0

摘要

研究目的本研究的目的是探讨与标准护理相比，使用人工智能的目标导向治疗是否可以减少单肺通气患者术中低血压的频率、持续时间和严重程度，并有可能减少术后急性肾损伤（AKI）。设计单中心、单盲、随机对照试验。大学医院手术室。纳入了150例接受单肺通气肺手术的患者。干预患者被随机分为两组：干预组，根据低血压预测指数（HPI）实施目标导向治疗；对照组，没有特定的血流动力学方案。主要观察指标包括术中低血压发生频率、持续时间、MAP 65下面积和MAP 65的时间加权平均值（TWA）。其他预后参数包括AKI发生率和非心脏手术后心肌损伤（MINS）。主要结果干预组低血压发作次数低于对照组(0次[0 - 1]比1次[0 - 2]；P = 0.01)，干预组低血压持续时间更短(0 min [0 - 3.17] vs. 2.33 min [0 - 7.42]；p = 0.01)。65 (0 mmHg * min [0 ~ 12] vs. 10.67 mmHg * min [0 ~ 44.16]；p & lt;MAP的TWA为65 (0 mmHg [0 - 0.08] vs. 0.07 mmHg [0 - 0.25])；p & lt;0.01)，低于干预组。两组术后AKI发生率无差异(6.7% vs. 4.2%；p = 0.72)。干预组min发生率有降低的趋势(17.1% vs. 31.8%；p = 0.07)。干预组有减少术后感染的趋势(16.0% vs 26.8%；p = 0.16)。结论基于HPI的治疗算法的实施使我们能够减少肺手术患者低血压的持续时间和严重程度。它没有导致AKI发生率的显著降低，但我们观察到干预组的MINS发生率有降低的趋势，同时术后感染也略有减少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Perioperative goal-directed therapy with artificial intelligence to reduce the incidence of intraoperative hypotension and renal failure in patients undergoing lung surgery: A pilot study

Study objective

The aim of this study was to investigate whether goal-directed treatment using artificial intelligence, compared to standard care, can reduce the frequency, duration, and severity of intraoperative hypotension in patients undergoing single lung ventilation, with a potential reduction of postoperative acute kidney injury (AKI).

Design

single center, single-blinded randomized controlled trial.

Setting

University hospital operating room.

Patients

150 patients undergoing lung surgery with single lung ventilation were included.

Interventions

Patients were randomly assigned to two groups: the Intervention group, where a goal-directed therapy based on the Hypotension Prediction Index (HPI) was implemented; the Control group, without a specific hemodynamic protocol.

Measurements

The primary outcome measures include the frequency, duration of intraoperative hypotension, furthermore the Area under MAP 65 and the time-weighted average (TWA) of MAP of 65. Other outcome parameters are the incidence of AKI and myocardial injury after non-cardiac surgery (MINS).

Main results

The number of hypotensive episodes was lower in the intervention group compared to the control group (0 [0–1] vs. 1 [0–2]; p = 0.01), the duration of hypotension was shorter in the intervention group (0 min [0–3.17] vs. 2.33 min [0–7.42]; p = 0.01). The area under the MAP of 65 (0 mmHg * min [0−12] vs. 10.67 mmHg * min [0–44.16]; p < 0.01) and the TWA of MAP of 65 (0 mmHg [0–0.08] vs. 0.07 mmHg [0–0.25]; p < 0.01) were lower in the intervention group.

The incidence of postoperative AKI showed no differences between the groups (6.7 % vs.4.2 %; p = 0.72). There was a trend to lower incidence of MINS in the intervention group (17.1 % vs. 31.8 %; p = 0.07). A tendency towards reduced postoperative infection was seen in the intervention group (16.0 % vs. 26.8 %; p = 0.16).

Conclusions

The implementation of a treatment algorithm based on HPI allowed us to decrease the duration and severity of hypotension in patients undergoing lung surgery. It did not result in a significant reduction in the incidence of AKI, however we observed a tendency towards lower incidence of MINS in the intervention group, along with a slight reduction in postoperative infections.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.