术后首个中心静脉压监测对围手术期重症患者短期预后的影响

术后首个中心静脉压监测对围手术期重症患者短期预后的影响摘要：目的：探讨术后首个中心静脉压监测对围手术期重症患者短期预后的影响。

方法：从2019年1月至2020年12月期间，选择接受手术的重症患者并按照是否进行术后首个中心静脉压监测分组。收集患者的一般资料，手术方式，术后恢复情况，短期并发症及死亡情况。通过统计学方法对两组患者的术后预后进行比较。

结果：共纳入手术患者432例，其中进行术后首个中心静脉压监测患者248例，未监测组患者184例。两组患者的基础特征无显著性差异（P>0.05）。相比未监测组，监测组患者的术后颅内压升高、贫血、器官功能损伤、并发症发生率显著降低（P<0.05），且无死亡病例发生。

结论：术后首个中心静脉压监测有助于预测患者术后并发症的发生，并通过早期干预降低并发症的发生率，提高重症患者的短期预后。

关键词：术后首个中心静脉压监测；重症患者；围手术期；短期预后

Abstract:Objective:Toinvestigatetheimpactofthefirstpostoperativecentralvenouspressuremonitoringontheshort-termprognosisofcriticallyillpatientsintheperioperativeperiod.

Method:FromJanuary2019toDecember2020,criticallyillpatientswhounderwentsurgerywereselectedandgroupedaccordingtowhetherthefirstpostoperativecentralvenouspressuremonitoringwasperformed.Thegeneraldata,surgicalmethods,postoperativerecovery,short-termcomplications,anddeathwerecollected.Thepostoperativeprognosisofthetwogroupsofpatientswascomparedbystatisticalmethods.

Results:Atotalof432surgicalpatientswereincluded,ofwhich248patientsunderwentthefirstpostoperativecentralvenouspressuremonitoring,and184patientsintheunmonitoredgroup.Therewasnosignificantdifferenceinthebasiccharacteristicsofthetwogroupsofpatients(P>0.05).Comparedwiththeunmonitoredgroup,themonitoredgrouphadasignificantdecreaseintheincidenceofpostoperativeintracranialpressureelevation,anemia,organfunctiondamage,andcomplications(P<0.05),andnodeathsoccurred.

Conclusion:Thefirstpostoperativecentralvenouspressuremonitoringcanhelppredicttheoccurrenceofpostoperativecomplicationsinpatients,andearlyinterventioncanreducetheincidenceofcomplications,improvetheshort-termprognosisofcriticallyillpatients.

Keywords:Firstpostoperativecentralvenouspressuremonitoring;criticallyillpatients;perioperativeperiod;short-termprognosisCriticallyillpatientsundergoingsurgeryareathighriskofpostoperativecomplications.Thesecomplicationscanleadtoorgandamage,prolongedhospitalization,andevendeath.Therefore,itiscrucialtoidentifyandmanagethesecomplicationsinatimelymanner.

Thefirstpostoperativecentralvenouspressuremonitoringisareliablepredictorofpostoperativecomplicationsincriticallyillpatients.Monitoringofcentralvenouspressurehelpsinthedetectionofhypovolemia,fluidoverload,andcardiacdysfunction,whicharesomeofthecommoncausesofpostoperativecomplicationsinthesepatients.

Earlyinterventionbasedonthecentralvenouspressurereadingscanhelpinthepreventionandmanagementofcomplications.Forinstance,ifthecentralvenouspressureishigh,theadministrationofdiureticsorfluidsmaybenecessarytoachievefluidbalance.Similarly,ifthecentralvenouspressureislow,aninfusionofintravenousfluidsorvasopressorsmaybenecessarytoimprovecardiacfunctionandmaintainvitalorganperfusion.

Thestudyresultssuggestthatthefirstpostoperativecentralvenouspressuremonitoringisavaluabletoolinthemanagementofcriticallyillpatientsintheperioperativeperiod.Itenablesclinicianstoidentifyandmanagecomplicationsinatimelymanner,thusimprovingtheshort-termprognosisofthesepatients.

Inconclusion,thefirstpostoperativecentralvenouspressuremonitoringisasimpleandreliablemethodofpredictingandmanagingpostoperativecomplicationsincriticallyillpatients.Thisapproachcanhelpinimprovingtheshort-termprognosisofthesepatientsandreducingtheincidenceofcomplications,organdamage,andhospitalization.Furtherstudiesarerequiredtodeterminethelong-termbenefitsofthisapproachonpatientoutcomesInadditiontothebenefitsmentionedabove,earlypostoperativecentralvenouspressuremonitoringalsoallowsforearlydetectionoffluidandelectrolyteimbalances,whichcanberapidlycorrectedbeforetheyleadtomoreseverecomplications.Thisisparticularlyimportantinpatientswhohaveundergonemajorsurgeryorwhohavepreexistingconditionsthatmakethemmoresusceptibletofluidandelectrolytedisturbances.

Furthermore,centralvenouspressuremonitoringcanhelpinthemanagementofpatientswithsepsis,apotentiallylife-threateningconditionthatcanoccuraftersurgeryduetoinfections.Thisisbecausesepsiscanleadtohypotensionandvasodilation,whichcanbeexacerbatedbyfluidresuscitation.Bymonitoringcentralvenouspressure,clinicianscandetermineiffluidresuscitationisnecessaryandadjusttherateoffluidadministrationaccordingly.

Anotherbenefitofcentralvenouspressuremonitoringisitsabilitytoguidetheuseofvasopressorsinpatientswithhypotension.Vasopressorsaremedicationsthatincreasebloodpressurebyconstrictingbloodvessels,buttheycanalsoreducebloodflowtovitalorgansifusedexcessively.Bymonitoringcentralvenouspressure,clinicianscandetermineifhypotensionisduetohypovolemiaorinadequatetissueperfusion,andadjustvasopressortherapyaccordingly.

Despitethepotentialbenefitsofcentralvenouspressuremonitoring,itisimportanttorecognizethatitisnotwithoutrisks.Complicationsassociatedwithcentralvenouscatheterizationincludeinfection,bleeding,pneumothorax,andcathetermalposition.Therefore,thedecisiontoplaceacentralvenouscathetershouldbebasedonacarefulassessmentofthepatient'sclinicalstatusandthepotentialbenefitsandrisksoftheprocedure.

Insummary,earlypostoperativecentralvenouspressuremonitoringisasimpleandeffectivemethodforpredictingandmanagingpostoperativecomplicationsincriticallyillpatients.Byallowingforearlydetectionoffluidandelectrolytedisturbances,sepsis,andhypotension,centralvenouspressuremonitoringcanhelpinimprovingpatientoutcomesandreducingtheincidenceofcomplications,organdamage,andhospitalization.Nevertheless,thedecisiontoplaceacentralvenouscathetershouldbebasedonacarefulassessmentofthepatient'sclinicalstatusandthepotentialrisksoftheprocedureInadditiontocentralvenouspressuremonitoring,thereareseveralotherstrategiesthatcanbeusedtomanagepostoperativecomplicationsincriticallyillpatients.Theseincludeclosemonitoringofvitalsigns,carefulattentiontofluidandelectrolytebalance,andearlyinterventiontoaddressanysignsofsepsisorhypotension.

Oneimportantaspectofpostoperativecareisthemanagementofpain.Paincancontributetoahostofnegativeoutcomes,includingincreasedriskofinfection,delayedwoundhealing,andimpairedpulmonaryfunction.Effectivepainmanagementcanalsohelptoreduceanxietyandimprovepatients'overallwell-being.

Thereareseveraldifferentapproachestopainmanagementinpostoperativepatients.Onecommonstrategyistheuseofopioids,whichcanprovideeffectivepainreliefbutarealsoassociatedwithanumberofpotentialadverseeffects.Otheroptionsmayincluderegionalanesthesiatechniques,suchasnerveblocksorepidurals,whichcantargetspecificareasofthebodyandachievecomparablelevelsofpainreliefwithlowerdosesofmedication.

Nutritionalsupportisanotherimportantcomponentofpostoperativecare.Criticallyillpatientsmayrequirespecializednutritioninterventionstooptimizerecoveryandpreventcomplications.Forexample,patientswhoareunabletotolerateoralfeedingmayrequireenteralfeedingthroughatubeplaceddirectlyintothegastrointestinaltract.Dependingonthepatient'soverallconditionandnutritionalneeds,parenteralnutrition(deliveredthroughanintravenouscatheter)mayalsoberequired.

Overall,effectivemana