复苏后的液体过载（FO）很常见，并导致伤后开腹（OA）患者的不良后果。生物电阻抗分析(BIA)是用于监测流体状态和FO的有前途的工具。因此,我们试图研究BIA定向液体复苏在OA患者中的疗效.
务实，prospective,随机化，观察者盲,在2013年1月至2017年12月期间,对所有需要OA的创伤患者到国家转诊中心进行单中心试验.共有140名受伤后OA患者以1：1的比例随机分配接受BIA指导的液体复苏（BIA）方案，其中包括液体给药，监测血液动力学参数和不同程度的干预措施，以实现针对BIA测量的水合水平（HL）或传统液体复苏（TRD）的负液体平衡，其中临床医生在30天的ICU管理期间根据传统参数确定液体复苏方案。主要结果是30天原发性筋膜闭合（PFC）率。次要结果包括PFC时间，术后7天累积液体平衡（CFB）和OA后30天内的不良事件。将Kaplan-Meier方法和对数秩检验用于OA后的PFC。建立了PFC和CFB时间的广义线性回归模型。
共有134名患者完成了试验(BIA，n=66；TRD，n=68）。BIA患者比TRD患者更有可能实现PFC（83.33％vs.55.88%,P<0.001)。在BIA组中，达到PFC的时间比TRD组平均早3.66天(P<0.001)。此外,BIA组术后7天CFB平均降低6632.80ml(P<0.001),并发症较少.
在ICU的创伤后OA患者中，与传统的液体复苏策略相比,使用BIA引导的液体复苏可获得更高的PFC率和更少的严重并发症.
Fluid overload (FO) after resuscitation is frequent and contributes to adverse outcomes among postinjury open abdomen (OA) patients. Bioelectrical impedance analysis (BIA) is a promising tool for monitoring fluid status and FO. Therefore, we sought to investigate the efficacy of BIA-directed fluid resuscitation among OA patients.
A pragmatic, prospective, randomized, observer-blind, single-center trial was performed for all trauma patients requiring OA between January 2013 and December 2017 to a national referral center. A total of 140 postinjury OA patients were randomly assigned in a 1:1 ratio to receive either a BIA-directed fluid resuscitation (BIA) protocol that included fluid administration with monitoring of hemodynamic parameters and different degrees of interventions to achieve a negative fluid balance targeting the hydration level (HL) measured by BIA or a traditional fluid resuscitation (TRD) in which clinicians determined the fluid resuscitation regimen according to traditional parameters during 30 days of ICU management. The primary outcome was the 30-day primary fascial closure (PFC) rate. The secondary outcomes included the time to PFC, postoperative 7-day cumulative fluid balance (CFB) and adverse events within 30 days after OA. The Kaplan-Meier method and the log-rank test were utilized for PFC after OA. A generalized linear regression model for the time to PFC and CFB was built.
A total of 134 patients completed the trial (BIA, n = 66; TRD, n = 68). The BIA patients were significantly more likely to achieve PFC than the TRD patients (83.33% vs. 55.88%, P < 0.001). In the BIA group, the time to PFC occurred earlier than that of the TRD group by an average of 3.66 days (P < 0.001). Additionally, the BIA group showed a lower postoperative 7-day CFB by an average of 6632.80 ml (P < 0.001) and fewer complications.
Among postinjury OA patients in the ICU, the use of BIA-guided fluid resuscitation resulted in a higher PFC rate and fewer severe complications than the traditional fluid resuscitation strategy.
PDF(Sci-hub)