术前聚焦心脏超声对高危患者的影响：一项随机对照试验

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术前聚焦心脏超声对高危患者的影响：一项随机对照试验

贵州医科大学  麻醉与心脏电生理课题组

翻译:马艳燕  编辑：马艳燕  审校：曹莹

背景：手术是全球第三大常见死亡原因。聚焦心脏超声（FOCUS）可以提供与心脏状态有关的信息，并揭示未知病理的存在。我们可以根据术前FOCUS结果，为患者制定特定的麻醉方案。假设术前FOCUS可以减少高危非心脏手术患者住院时间超过10天或30天内死亡的比例。

方法：这是一项随机、对照、多中心的研究。纳入标准为年龄≥65岁，因紧急骨科或腹部手术入院，计划行全身或椎管内麻醉且ASA为3或4级的患者。患者以1：1的比例随机分配，一组术前行FOCUS检查，另外一组没有进行检查，按照预先确定的方案进行手术。主要结局指标是入院超过10天或在30天内死亡的患者比例。次要结局指标包括主要并发症、入院天数和麻醉处理的变化。

结果：在第二次新冠肺炎浪潮期间，研究监测委员会提前终止了研究。我们纳入了338名患者，对其中327名进行最终分析。在FOCUS组中，符合主要结局指标标准的患者为41/163(25%)名，而对照组为35/164(21%)名，调整后的优势比为1.37(95%CI为0.86-2.30)，p=0.36。发生主要并发症患者的比例在不同组之间没有显著差异。FOCUS组的住院时间为4(3-8)天，对照组为4(3-7)天(调整后p=0.24)。

结论：尽管研究提前终止，但该队列研究中常规的术前FOCUS评估不能降低患者住院时间超过10天或30天死亡的比例。

原始文献来源：Pallesen J, Bhavsar R, Fjølner J, Bakke SA, Krog J, Andersen MAS, Bøndergaard MH, Jessing TD, Mortensen L, Nielsen MB, Vang M, Malachauskiené L, Juhl-Olsen P. The effects of preoperative focused cardiac ultrasound in high-risk patients: A randomised controlled trial (PREOPFOCUS). Acta Anaesthesiol Scand. 2022 Nov;66(10):1174-1184. doi: 10.1111/aas.14134. Epub 2022 Aug 29. PMID: 36054287.

英文原文：

The effects of preoperative focused cardiac ultrasound in high-risk patients: A randomised controlled trial (PREOPFOCUS)

Background: Surgery is the third most common cause of mortality worldwide.Focused cardiac ultrasound (FOCUS) yields information on cardiac status and discloses the presence of unknown pathology. Preoperative FOCUS changes patient treatment, allowing for a patient-tailored anaesthesia. We hypothesised that preoperative FOCUS would reduce the proportion of patients who were either admitted to hospital for more than 10 days or who were dead within 30 days after high-risk, non cardiac surgery.

Methods： This was a randomised, controlled, multi-center study. Patients ≥65 years of age, admitted for urgent orthopaedic- or abdominal surgery, scheduled for general- or neuraxial anaesthesia and with ASA 3/4 were eligible for inclusion. Patients were randomised in a 1:1 ratio to preoperative FOCUS or no preoperative FOCUS performed in accordance with a predefined protocol. Primary endpoint was the proportion of patients admitted more than 10 days or who were dead within 30 days. Secondary endpoints included major complications, days of admission and changes in anaesthesia handling.

Results: During the second COVID-19 wave the study monitoring committee terminated the study prematurely. We included 338 patients of which 327 were included in the final analysis. In the FOCUS group, 41/163 (25%) patients met the criteria for the primary endpoint versus 35/164 (21%) for the control group, adjusted odds ratio 1.37 (95% CI 0.86–2.30), p = .36. The proportions of patients who developed major complications did not differ significantly between groups. Length of hospital stay was 4 ( 3–8) days in the FOCUS group and 4 (3–7) days on the control group (adjusted p = .24).

Conclusion:The routine availability of preoperative FOCUS assessment in this cohort does not appear to reduce the risk for hospitalisation exceeding 10 days or 30-day mortality, although study enrolment was prematurely terminated.