使用FloTrac/EV1000平台进行术中血流动力学优化以实现早期目标导向治疗对接受体外循环冠状动脉搭桥术患者术后结局的改善作用：一项随机对照试验
Efficacy of Intraoperative Hemodynamic Optimization Using FloTrac/EV1000 Platform for Early Goal-Directed Therapy to Improve Postoperative Outcomes in Patients Undergoing Coronary Artery Bypass Graft with Cardiopulmonary Bypass: A Randomized Controlled Trial.
作者信息
Tribuddharat Sirirat, Sathitkarnmanee Thepakorn, Ngamsangsirisup Kriangsak, Nongnuang Krisana
机构信息
Department of Anesthesiology, Faculty of Medicine, Khon Kaen University, Khon Kaen, 40002, Thailand.
Phramongkutklao Hospital, Bangkok, 10400, Thailand.
出版信息
Med Devices (Auckl). 2021 Jun 28;14:201-209. doi: 10.2147/MDER.S316033. eCollection 2021.
PURPOSE
Early goal-directed therapy (EGDT) using the FloTrac system reportedly improved postoperative outcomes among high-risk patients undergoing non-cardiac surgery. This study's objective was to evaluate the FloTrac/EV1000 platform's efficacy for improving postoperative outcomes in cardiac surgery.
PATIENTS AND METHODS
Eighty-six adults undergoing coronary artery bypass graft (CABG) with cardiopulmonary bypass (CPB) in 2 tertiary referral centers were randomized to the EGDT or Control group. The Control group was managed with standard care to achieve the following goals: mean arterial pressure 65-90 mmHg; central venous pressure 8-12 mmHg; urine output ≥0.5 mL·kg·h; oxygen saturation >95%; and hematocrit 26-30%. The EGDT group was managed to reach similar goals using information from the FloTrac/EV1000 monitor. The targets were stroke volume variation <13%; stroke volume index 33-65 mL·beat·m; cardiac index 2.2-4.0 L·min·m; and systemic vascular resistance index 1600-2500 dynes·s·cm·m.
RESULTS
The intensive care unit (ICU) stay of the EGDT group was significantly shorter (mean difference -29.5 h; 95% CI -17.2 to -41.8, < 0.001). The mechanical ventilation time was also shorter in the EGDT group (mean difference -11.3 h; 95% CI -2.7 to -19.9, = 0.011). The hospital LOS was shorter in the EGDT group (mean difference -1.1 d; 95% CI -0.1 to -2.1, = 0.038).
CONCLUSION
EGDT using FloTrac/EV1000 can be applied in CABG with CPB to improve postoperative outcomes.
目的
据报道，使用FloTrac系统的早期目标导向治疗（EGDT）可改善接受非心脏手术的高危患者的术后结局。本研究的目的是评估FloTrac/EV1000平台在改善心脏手术术后结局方面的疗效。
患者与方法
在2个三级转诊中心，86例接受冠状动脉旁路移植术（CABG）并使用体外循环（CPB）的成人患者被随机分为EGDT组或对照组。对照组采用标准治疗以实现以下目标：平均动脉压65 - 90 mmHg；中心静脉压8 - 12 mmHg；尿量≥0.5 mL·kg·h；血氧饱和度>95%；血细胞比容26 - 30%。EGDT组利用FloTrac/EV1000监测仪提供的信息来实现类似目标。目标为每搏量变异<13%；每搏量指数33 - 65 mL·beat·m；心脏指数2.2 - 4.0 L·min·m；全身血管阻力指数1600 - 2500 dynes·s·cm·m。
结果
EGDT组的重症监护病房（ICU）住院时间显著缩短（平均差值 -29.5小时；95%置信区间 -17.2至 -41.8，P<0.001）。EGDT组的机械通气时间也较短（平均差值 -11.3小时；95%置信区间 -2.7至 -19.9，P = 0.011）。EGDT组的住院时间较短（平均差值 -1.1天；95%置信区间 -0.1至 -2.1，P = 0.038）。
结论
使用FloTrac/EV1000的EGDT可应用于采用CPB的CABG手术，以改善术后结局。
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