动脉脉搏波分析装置与高危非心脏手术患者住院死亡率的关系
围术期目标导向液体疗法用于高危手术患者的血流动力学优化。
动脉脉搏波分析装置与高危非心脏手术患者住院死亡率的关系
贵州医科大学 高鸿教授课题组
翻译：马艳燕 编辑：佟睿 审校：曹莹
围术期目标导向液体疗法用于高危手术患者的血流动力学优化。心输出量可用专用的动脉脉搏波形分析(S-APWA)压力传感器监测。目前还没有研究评估S-APWA在实际情况中的使用是否与术后转归相关；因此，我们利用日本行政索赔数据库，回顾性调查了在全麻下接受高风险手术的患者中，S-APWA的使用是否与住院死亡率有关。
2014年至2016年在全身麻醉和动脉置管下接受高危手术的成年患者被分为S-APWA组和传统动脉压传感器组，然后比较基线因素和预后。采用Logistic回归分析比较住院死亡率。根据手术类型和患者的合并症，亚组分析评估S-APWA疗效和预后。
23655例患者中6859例(29.0%)使用了S-APWA；住院死亡率约为3.5%。调整后的分析显示，S-APWA的使用与住院死亡率没有显著关联(调整后的优势比[AOR]=0.91；95%可信区间[CI]：0.76-1.07；P=0.25)。进行血管手术的患者使用S-APWA的住院死亡率显著降低(AOR=0.67；95%CI：0.49-0.94)，进行下肢截肢患者的住院死亡率显著升高(AOR=2.63；95%CI：1.32-5.22)。在其他亚组中，S-APWA的使用和住院死亡率没有显著关联。
在整个研究人群中，S-APWA的使用与住院死亡率无关。然而，S-APWA与血管外科患者住院死亡率的降低和下肢截肢患者住院死亡率的升高有关。
Takeda C, Takeuchi M, Mizota T, et al. The association between arterial pulse waveform analysis device and in-hospital mortality in high-risk non-cardiac surgeries. Acta Anaesthesiol Scand. 2020 Aug;64(7):928-935.
The Association Between Arterial Pulse Waveform Analysis Device and In-Hospital Mortality in High-Risk Non-Cardiac Surgeries
Background: Perioperative goal-directed fluid therapy is used for haemodynamic optimisation in high-risk surgeries. Cardiac output monitoring can be performed by a specialised pressure transducer for arterial pulse waveform analysis (S-APWA).No study has assessed whether real-world use of S-APWA is associated with postoperative outcomes; therefore, using a Japanese administrative claims database, we retrospectively investigated whether S-APWA use is associated with in-hospital mortality among patients undergoing high-risk surgery under general anaesthesia.
Methods: Adult patients who underwent high-risk surgery under general anaesthesia and arterial catheterisation between 2014 and 2016 were divided into S-APWA and conventional arterial pressure transducer groups, then compared regarding baseline factors and outcomes. Logistic regression analysis was performed to compare in-hospital mortality. Subgroup analyses evaluated S-APWA efficacy and outcomes based on the type of surgery and patients’ comorbidity.
Results: S-APWA was used in 6,859 of 23,655 (29.0%) patients; the crude in-hospital mortality rate was 3.5%. Adjusted analysis showed no significant association between S-APWA use and in-hospital mortality rate (adjusted odds ratio [aOR]=0.91; 95% confidence interval [CI]: 0.76–1.07; P=0.25). S-APWA use was associated with significantly lower in-hospital mortality in patients undergoing vascular surgery (aOR=0.67; 95%CI: 0.49–0.94), and significantly higher in-hospital mortality in patients undergoing lower limb amputation (aOR=2.63; 95%CI: 1.32–5.22). S-APWA use and in-hospital mortality were not significantly associated in other subgroups.
Conclusion: S-APWA use was not associated with in-hospital mortality in the entire study population. However, S-APWA was associated with decreased in-hospital mortality among vascular surgery and increased in-hospital mortality among lower limb amputation.
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