HEMODYNAMIC AND OXYGEN-TRANSPORT RESPONSES IN SURVIVORS AND NONSURVIVORS OF HIGH-RISK SURGERY
HEMODYNAMIC AND OXYGEN-TRANSPORT RESPONSES IN SURVIVORS AND NONSURVIVORS OF HIGH-RISK SURGERY
复制标题
DOI：
10.1097/00003246-199307000-00010
复制
发表时间：
1993-07-01
影响因子：
8.8
通讯作者：
KRAM, HB
中科院分区：
文献类型：
--
作者：
SHOEMAKER, WC;APPEL, PL;KRAM, HB
目的：描述时间的血流动力学和氧运输模式在一个大的系列的高风险的外科手术患者，以记录生理模式，制定治疗目标的范围广泛的手术条件，并提出一个机械模型急性术后循环failure.Design：前瞻性，纵向研究。对确定为高风险的患者进行前瞻性研究。数据采集后立即进行分析，每天两次进行正式调查，并在监测完成后进行正式数据审查。A university-run county hospital.Patients：患者系列包括708个连续监测的高风险手术patients.Interventions：血流动力学和氧运输值和他们对手术创伤的反应是众所周知的，随着年龄和先前的医疗条件有很大的不同，他们可以用来预测结果具有高度的准确性。一个大系列的高风险的外科手术的时间血流动力学和氧运输模式进行了治疗的一组，使用一个完善的protocol.Measurements和主要结果：血流动力学和氧运输监测变量进行了分析之前，期间，并在频繁的间隔后，外科手术。我们对以下各组中存活者和非存活者的时间模式进行分层：a）无心血管疾病证据且术前基线心脏指数值正常的患者;和B）由于存在术前确定的影响循环状态的医学状况而具有高或低术前基线心脏指数值的患者。此外，我们对不同年龄段的无已知心血管疾病的患者进行了分层。本研究分析了超过20，000个数据集，每个数据集中多达32个变量或> 500，000个值。主要发现是术中循环功能下降，主要是心脏指数值、氧输送（DO 2）和氧消耗（VO 2）。这些术中循环功能的降低，在术后早期，这些变量增加。存活者的心脏指数、DO 2和VO 2值的术后增加大于非存活者;当每个分层的术后模式与其自身的术前对照值相关时，这些发现更加明显。数据表明，手术创伤后代谢需求增加，心脏指数和DO 2的变化代表循环功能的代偿性增加受代谢需求增加的刺激。然而，这些代谢需求随着年龄、性别、疾病严重程度、手术类型、相关医疗条件、休克持续时间、并发症、器官衰竭和结局而变化。
Objectives: To describe temporal hemodynamic and oxygen transport patterns in a large series of high-risk surgical patients in order to document physiologic patterns, to develop therapeutic goals for a wide range of surgical conditions, and to propose a mechanistic model for acute postoperative circulatory failure.Design: Prospective, longitudinal study. Patients identified as high risk were studied prospectively. The data were analyzed immediately after they were acquired, again on formal rounds twice daily, and at a formal data review after completion of monitoring.Setting. A university-run county hospital.Patients: The patient series consisted of 708 consecutively monitored high-risk surgical patients.Interventions: Hemodynamic and oxygen transport values and their responses to surgical trauma are known to vary widely with age and prior medical conditions; they may be used to predict outcome with a high degree of accuracy. Temporal hemodynamic and oxygen transport patterns in a large series of high-risk surgical operations were treated by one group, using a well-developed protocol.Measurements and Main Results: Hemodynamic and oxygen transport monitored variables were analyzed before, during, and at frequent intervals after surgical operations. We stratified the temporal patterns of survivors and nonsurvivors in each of the following groups: a) patients without evidence of cardiovascular disease whose preoperative baseline cardiac index values were normal; and b) patients with high or low preoperative baseline cardiac index values due to the presence of preoperatively identified medical conditions that affect the circulatory status. In addition, we stratified patients in various age ranges who were without known cardiovascular diseases. The present study analyzed over 20,000 data sets with up to 32 variables in each data set or >500,000 values.The major findings were intraoperatively reduced circulatory functions, principally cardiac index values, oxygen delivery (DO2), and oxygen consumption (VO2). These reductions in circulatory functions intraoperatively were followed, in the early postoperative period, by increases in these variables. The postoperative increases in cardiac index, DO2, and VO2 values were greater in survivors than in nonsurvivors; these findings were more apparent when the postoperative patterns of each strata were related to their own preoperative control values.Conclusions: The data indicate that there are increased metabolic requirements after surgical trauma and that the changes in cardiac index and DO2 represent compensatory increases in circulatory functions stimulated by increased metabolic needs. However, these metabolic needs change with age, gender, severity of illness, type of operation, associated medical conditions, duration of shock, complications, organ failure, and outcome.