A RANDOMIZED CLINICAL-TRIAL OF THE EFFECT OF DELIBERATE PERIOPERATIVE INCREASE OF OXYGEN DELIVERY ON MORTALITY IN HIGH-RISK SURGICAL PATIENTS
A RANDOMIZED CLINICAL-TRIAL OF THE EFFECT OF DELIBERATE PERIOPERATIVE INCREASE OF OXYGEN DELIVERY ON MORTALITY IN HIGH-RISK SURGICAL PATIENTS
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DOI：
10.1001/jama.270.22.2699
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发表时间：
1993-12-08
影响因子：
120.7
通讯作者：
BENNETT, ED
中科院分区：
文献类型：
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作者：
BOYD, O;GROUNDS, RM;BENNETT, ED
目的.-评估围手术期刻意增加氧气输送量对手术后高风险患者死亡率和发病率的影响。设计.-前瞻性随机临床试验。地点.-英国伦敦一家教学医院普通重症监护病房。患者.-在 18 个月的时间内对根据先前确定的标准被评估为高风险的总共 107 名手术患者进行了研究。干预措施.-患者被随机分配到对照组(n = 54) 接受最佳标准围手术期护理，或方案组 (n = 53)，此外，通过使用盐酸多培胺输注有意将氧输送指数增加到每平方米 600 mL/min 以上。结果测量。-术后 28 天评估死亡率和并发症。结果。-各组在人口统计学、入院标准、手术类型和入院血流动力学变量方面相似。对各组进行类似的治疗以维持血压、动脉饱和度、血红蛋白浓度和肺动脉闭塞压；然而，一旦给予盐酸多培沙明额外治疗，方案组术前氧气输送量显着更高（中位值，每平方米 597 毫升/分钟 vs 399 毫升/分钟；P
Objective.-To assess the effect of deliberate perioperative increase in oxygen delivery on mortality and morbidity in patients who are at high risk of both following surgery.Design.-Prospective, randomized clinical trial.Setting.-A teaching hospital general intensive care unit, London, England.Patients.-A total of 107 surgical patients, who were assessed as high risk from previously identified criteria, were studied during an 18-month period.Interventions.-Patients were randomly assigned to a control group (n=54) that received best standard perioperative care, or to a protocol group (n=53) that, in addition, had deliberate increase of oxygen delivery index to greater than 600 mL/min per square meter by use of dopexamine hydrochloride infusion.Outcome Measures.-Mortality and complications were assessed to 28 days postoperatively.Results.-Groups were similar with respect to demographics, admission criteria, operation type, and admission hemodynamic variables. Groups were treated similarly to maintain blood pressure, arterial saturation, hemoglobin concentration, and pulmonary artery occlusion pressure; however, once additional treatment with dopexamine hydrochloride had been given, the protocol group had significantly higher oxygen delivery preoperatively (median, 597 vs 399 mL/min per square meter; P