IMPROVEMENT OF OUTCOMES AFTER CORONARY-ARTERY BYPASS - A RANDOMIZED TRIAL COMPARING INTRAOPERATIVE HIGH VERSUS LOW MEAN ARTERIAL-PRESSURE
IMPROVEMENT OF OUTCOMES AFTER CORONARY-ARTERY BYPASS - A RANDOMIZED TRIAL COMPARING INTRAOPERATIVE HIGH VERSUS LOW MEAN ARTERIAL-PRESSURE
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DOI：
10.1016/s0022-5223(95)70053-6
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发表时间：
1995-11-01
影响因子：
6
通讯作者：
ISOM, OW
中科院分区：
文献类型：
--
作者：
GOLD, JP;CHARLSON, ME;ISOM, OW
背景 这项择期冠状动脉旁路移植术的随机临床试验的目的是调查术中平均动脉压低于冠状动脉和脑循环的自动调节极限是否是术后并发症的主要决定因素。该试验比较了体外循环期间两种血流动力学管理策略对结果的影响。在体外循环期间，患者被随机分配至 50 至 60 mm Hg 的低平均动脉压或 80 至 100 mm Hg 的高平均动脉压。方法 共有 248 名接受初次非紧急冠状动脉搭桥术的患者在体外循环期间被随机分为低平均动脉压 (n = 124) 或高平均动脉压 (n = 124)。评估了平均动脉压策略对以下结果的影响：死亡率、心脏病发病率、神经系统发病率、认知恶化和生活质量变化。所有患者均进行前瞻性观察至术后6个月。结果 高压组心脏和神经系统并发症的总体发生率为 4.8%，显着低于低压组的 12.9%（p = 0.026）。对于每一个单独的结果，趋势有利于高压组。高压组和低压组冠状动脉搭桥术后 6 个月时，总死亡率分别为 1.6% 和 4.0%，卒中发生率分别为 2.4% 和 7.2%，心脏并发症发生率分别为 2.4% 和 4.8%。各组之间的认知和功能状态结果没有差异。结论 体外循环期间可以通过技术安全的方式实现较高的平均动脉压，并有效改善冠状动脉搭桥术后的预后。
Background The objective of this randomized clinical trial of elective coronary artery bypass grafting was to investigate whether intraoperative mean arterial pressure below autoregulatory limits of the coronary and cerebral circulations was a principal determinant of postoperative complications. The trial compared the impact of two strategies of hemodynamic management during cardiopulmonary bypass on outcome. Patients were randomized to a low mean arterial pressure of 50 to 60 mm Hg or a high mean arterial pressure of 80 to 100 mm Hg during cardiopulmonary bypass. Methods A total of 248 patients undergoing primary, nonemergency coronary bypass, were randomized to either low (n = 124) or high (n = 124) mean arterial pressure during cardiopulmonary: bypass. The impact of the mean arterial pressure strategies on the following outcomes was assessed: mortality, cardiac morbidity, neurologic morbidity, cognitive deterioration, and changes in quality of life. All patients were observed prospectively to 6 months after the operation. Results The overall incidence of combined cardiac and neurologic complications was significantly lower in the high pressure group at 4.8% than in the low pressure group at 12.9% (p = 0.026). For each of the individual outcomes, the trend favored the high pressure group. At 6 months after coronary bypass for the high and low pressure groups, respectively, total mortality rate was 1.6% versus 4.0%, stroke rate 2.4% versus 7.2%, and cardiac complication rate 2.4% versus 4.8%. Cognitive and functional status outcomes did not differ between the groups. Conclusion Higher mean arterial pressures during cardiopulmonary bypass can be achieved in a technically safe manner and effectively improve outcomes after coronary bypass.