Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery
Reducing the risk of major elective surgery: randomised controlled trial of preoperative optimisation of oxygen delivery
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DOI：
10.1136/bmj.318.7191.1099
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发表时间：
1999-04-24
影响因子：
--
通讯作者：
McManus, E
中科院分区：
文献类型：
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作者：
Wilson, J;Woods, I;McManus, E
目的确定术前氧输送的优化是否能改善重大择期手术后的结果，并确定用于增强氧输送的正性肌力药肾上腺素和多巴酚丁胺是否会影响结果。设计正性肌力药组间双盲随机对照试验。设置约克区医院，受试者138例接受择期大手术的患者，由于手术或共存的药物存在，他们有发生术后并发症的风险。条件干预患者被随机分为三组。两组均接受有创血流动力学监测、液体和肾上腺素或多巴酚丁胺以增加氧气输送，手术期间和术后至少12小时继续进行变力性支持。第三组（对照组）接受常规围手术期护理。主要结局指标医院死亡率和发病率。结果总体而言，3/92（3%）preoptimized患者死亡相比，8/46对照组（17%）（P = 0.007）。治疗组之间的死亡率没有差异，但多培沙明组有14/46（30%）例患者发生并发症，肾上腺素组有24/46（52%）例患者（差异22%，95%置信区间2%至41%），对照组有28例患者（61%）（31%，11%至50%）。使用dopexamine是与住院时间减少。结论常规的术前优化的患者进行大的择期手术将是一个显着的和具有成本效益的改善围手术期护理。
Objectives To determine whether preoperative optimisation of oxygen delivery improves outcome after major elective surgery, and to determine whether the inotropes, adrenaline and dopexamine, used to enhance oxygen delivery influence outcome.Design Randomised controlled trial with double blinding between inotrope groups.Setting York District Hospital, England.Subjects 138 patients undergoing major elective surgery who were at risk of developing postoperative complications either because of the surgery or the presence of coexistent medical conditions. Interventions Patients were randomised into three groups. Two groups received invasive haemodynamic monitoring, fluid, and either adrenaline or dopexamine to increase oxygen delivery Inotropic support was continued during surgery and for at least 12 hours afterwards. The third group (control) received routine perioperative care.Main outcome measures Hospital mortality and morbidity.Results Overall, 3/92 (3%) preoptimised patients died compared with 8/46 controls (17%) (P = 0.007). There were no differences in mortality between the treatment groups, but 14/46 (30%) patients in the dopexamine group developed complications compared with 24/46 (52%) patients in the adrenaline group (difference 22%, 95% confidence interval 2% to 41%) and 28 patients (61%) in the control group (31%, 11% to 50%). The use of dopexamine was associated with a decreased length of stay in hospital.Conclusion Routine preoperative optimisation of patients undergoing major elective surgery would be a significant and cost effective improvement in perioperative care.