医学
四分位间距
围手术期
利钠肽
内科学
外科
脑利钠肽
随机对照试验
胃肠病学
麻醉
心力衰竭
作者
Birgitte Brandstrup,Randi Beier-Holgersen,Lene Hjerrild Iversen,Christian Starup,Loui N Wentzel,Karen Lindorff-Larsen,T. C. Petersen,Hanne Tønnesen
出处
期刊:Annals of Surgery
[Ovid Technologies (Wolters Kluwer)]
日期:2019-12-10
卷期号:272 (6): 941-949
被引量:6
标识
DOI:10.1097/sla.0000000000003724
摘要
Objective: To investigate the influence of intravenous (iv) fluid volumes on the secretion of N-terminal-pro-brain natriuretic peptide (NT-Pro-BNP) in colorectal surgical patients and its association with cardiopulmonary complications (CPC). In addition, to examine if preoperative NT-Pro-BNP can predict the risk for postoperative CPC. Methods: Blood samples from patients enrolled in a previously published clinical randomized assessor-blinded multicenter trial were analyzed. 1 Included were adult patients undergoing elective colorectal surgery with the American-Society-of-Anesthesiologists-scores of 1–3. Samples from 135 patients were available for analysis. Patients were allocated to either a restrictive (R-group) or a standard (S-group) iv-fluid regimen, commencing preoperatively and continuing until discharge. Blood was sampled every morning until the fourth postoperative day. The primary outcome for this study was NT-Pro-BNP changes and its association with fluid therapy and CPC. Results: The S-group received more iv-fluid than the R-group on the day-of-surgery [milliliter, median (range) 6485 (4401–10750) vs 3730 (2250–8510); P < 0.001] and on the first postoperative day. NT-Pro-BNP was elevated in the S-group compared with the R-group on all postoperative days [area under the curve: median (interquartile range) pg/mL: 3285 (1697–6179) vs 1290 (758–3719); P < 0.001 and in patients developing CPC vs no-CPC (area under the curve), median (interquartile range): 5196 (1823–9061) vs 1934 (831–5301); P = 0.005]. NT-pro-BNP increased with increasing fluid volumes all days ( P < 0.003). Preoperative NT-Pro-BNP predicted CPC [odds ratio (confidence interval): 1.573 (0.973–2.541), P = 0.032; positive predictive value = 0.257, negative predictive value = 0.929]. Conclusions: NT-pro-BNP increases with iv-fluid volumes given to colorectal surgical patients, and the level of NT-Pro-BNP is associated with CPC. Preoperative NT-Pro-BNP is predictive for CPC, but the diagnostic value is low. Clinicaltrials.gov NCT03537989.
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