Randomized Evidence for Reduction of Perioperative Mortality
Randomized Evidence for Reduction of Perioperative Mortality
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DOI：
10.1053/j.jvca.2012.04.018
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发表时间：
2012-10-01
影响因子：
2.8
通讯作者：
Zangrillo, Alberto
中科院分区：
文献类型：
--
作者：
Landoni, Giovanni;Rodseth, Reitze N.;Zangrillo, Alberto
目的：每年进行超过2.2亿次大手术，围手术期干预即使导致死亡率降低很小，每年也会挽救数千人的生命。本次国际共识会议旨在确定所有增加或减少围手术期死亡率的非手术干预措施，如随机证据所示。设计和设置：基于网络的国际共识会议。参与者：来自77个国家的1,000多名医生参加了这次基于网络的共识会议。干预措施：系统性文献检索（MEDLINE/Pub Med，2011年6月8日）用于识别对死亡率有统计学显著影响的论文，并与专家联系。如果干预措施（1）在同行评议的期刊上发表，（2）涉及非手术干预，则认为这些干预措施符合评价条件（药物/技术/策略）在接受手术的成人患者中的应用，以及（3）提供了统计学上显著的死亡率增加或减少，如随机试验或随机试验的荟萃分析所建议的。确定了14种可能改变成人手术围手术期死亡率的干预措施。可能降低死亡率的干预措施包括洗必泰口腔冲洗液、可乐定、胰岛素、主动脉内球囊反搏、白细胞耗竭、左西孟旦、轴索麻醉、无创呼吸支持、血流动力学优化、氧气、选择性消化道净化和挥发性麻醉剂。相比之下，抑肽酶和缓释美托洛尔可能会增加mortality.Conclusions：未来的研究和医疗保健资金应针对研究和评估这些干预措施。(C)2012 Elsevier Inc. All rights reserved.
Objective: With more than 220 million major surgical procedures performed annually, perioperative interventions leading to even minor mortality reductions would save thousands of lives per year. This international consensus conference aimed to identify all nonsurgical interventions that increase or reduce perioperative mortality as suggested by randomized evidence.Design and Setting: A web-based international consensus conference.Participants: More than 1,000 physicians from 77 countries participated in this web-based consensus conference.Interventions: Systematic literature searches (MEDLINE/Pub Med, June 8, 2011) were used to identify the papers with a statistically significant effect on mortality together with contacts with experts. Interventions were considered eligible for evaluation if they (1) were published in peer-reviewed journals, (2) dealt with a nonsurgical intervention (drug/technique/strategy) in adult patients undergoing surgery, and (3) provided a statistically significant mortality increase or reduction as suggested by a randomized trial or meta-analysis of randomized trials.Measurements and Main Results: Fourteen interventions that might change perioperative mortality in adult surgery were identified. Interventions that might reduce mortality include chlorhexidine oral rinse, clonidine, insulin, intra-aortic balloon pump, leukodepletion, levosimendan, neuraxial anesthesia, noninvasive respiratory support, hemodynamic optimization, oxygen, selective decontamination of the digestive tract, and volatile anesthetics. In contrast, aprotinin and extended-release metoprolol might increase mortality.Conclusions: Future research and health care funding should be directed toward studying and evaluating these interventions. (C) 2012 Elsevier Inc. All rights reserved.