所有接受非心脏手术的肺动脉高压患者都应该由受过心胸奖学金培训的麻醉师管理吗?

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Accounts of Chemical Research Pub Date : 2023-12-01 Epub Date: 2023-09-19 DOI:10.1177/10892532231203128
Meena Bhatia, Christopher J Scheiber, Simrat Arora, Chelsea Gustafson, Ian Funk, Craig Grosshuesch, Carter Simmers, Quefeng Li, Yutong Liu, Alan M Smeltz
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引用次数: 1

摘要

目的:确定已完成心胸造影研究(CTA组)的麻醉师与未完成的(非CTA组的)麻醉师对肺动脉高压(PH)患者进行全麻诱导的实践模式和结果的差异。设计:倾向评分匹配的回顾性研究。设置:手术室。参与者:所有在单一学术中心接受全麻并需要插管5年以上的PH成年患者。干预措施:比较CTA组和非CTA组的患者基线特征、诱导期管理变量、诱导后平均动脉压(MAP)和其他结果。方法和主要结果:在倾向评分匹配后,402名患者被纳入最终模型,100名被纳入CTA组,302名被纳入非CTA组。同样在匹配后,只有轻度至中度PH且无右心室功能障碍的病例仍保留在分析中。匹配组在基线特征方面总体上具有统计学相似性;然而,CTA组管理的ASA等级较高(P=.025)和心脏病学和胸部手术(P<.001)的发生率更高。在与组间麻醉诱导相关的实践模式或结果方面没有发现统计学差异,除了CTA组住院时间更长(P=0.008)。结论:这些结果提供了早期证据,表明有或没有心胸研究的麻醉师可以对非严重PH疾病患者进行全身麻醉诱导。然而,这些发现应该在前瞻性研究中得到证实。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Should All Patients With Pulmonary Hypertension Undergoing Non-Cardiac Surgery Be Managed by Cardiothoracic Fellowship-Trained Anesthesiologists?

Objectives: To identify differences in practice patterns and outcomes related to the induction of general anesthesia for patients with pulmonary hypertension (PH) performed by anesthesiologists who have completed a cardiothoracic fellowship (CTA group) vs those who have not (non-CTA group).

Design: Retrospective study with propensity score matching.

Setting: Operating room.

Participants: All adult patients with PH undergoing general anesthesia requiring intubation at a single academic center over 5 years.

Interventions: Patient baseline characteristics, peri-induction management variables, post-induction mean arterial pressure (MAP), and other outcomes were compared between CTA and non-CTA groups.

Methods and main results: Following propensity scoring matching, 402 patients were included in the final model, 100 in the CTA group and 302 in the non-CTA group. Also following matching, only cases of mild to moderate PH without right ventricular dysfunction remained in the analysis. Matched groups were overall statistically similar with respect to baseline characteristics; however, there was a greater incidence of higher ASA class (P = .025) and cardiology and thoracic procedures (P < .001) being managed by the CTA group. No statistical differences were identified in practice patterns or outcomes related to the induction of anesthesia between groups, except for longer hospital length of stay in the CTA group (P = .008).

Conclusions: These results provide early evidence to suggest the induction of general anesthesia of patients with non-severe PH disease can be comparably managed by either anesthesiologists with or without a cardiothoracic fellowship. However, these findings should be confirmed in a prospective study.

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来源期刊
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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