中高危非心脏手术患者术中低血压的发生率：回顾性多中心观察分析

研究目的：术中低血压与围术期并发症有关。我们进行这项研究来观察低血压的发生率(低血压定义为平均动脉压MAP<65mmHg)。

设计：回顾性、观察性研究。

背景：本研究在术中进行。

受试者：从2017年1月1日至2017年12月31日期间，我们共纳入了22,109名ASA分级III-IV级、手术时长≥180min以及术中行有创动脉监测血压的成人患者。

干预措施：无。

测量方法：我们主要测量有创平均动脉压<65mmHg的时长。此外，我们收集了患者病史数据，并按Elixhauser合并症增强型ICD-9-CM/ICD-10 CM算法分类。其他研究变量包括年龄、性别、体重指数、术前血压、ASA身体状况分级、未使用过血管活性药物(去氧肾上腺素、去甲肾上腺素、加压素)、评估失血量、浓缩红细胞输注量、以及根据主要的麻醉学现行医学术语（CPT）代码和身体部位为特征的外科手术分类。

主要结果：MAP<65 mmHg的平均持续时间为28.2 min(SD 42.6)。88%的病例术中至少出现一次MAP<65 mmHg并持续1 min的低血压事件。在各个医疗中心，这一比例为83.2%～91.6%不等。低血压平均持续时间为22.1min～31.8min。

结论：通过我们的多中心医院队列研究，低血压（MAP<65 mmHg）仍是手术中的频发事件。

原始文献来源: Shah NJ, Mentz G, Kheterpal S,et al.The incidence of intraoperative hypotension in moderate to high risk patients undergoing noncardiac surgery: A retrospective multicenter observational analysis.[J].J Clin Anesth 2020 Jul 11;66.

The incidence of intraoperative hypotension in moderate to high risk patients undergoing non-cardiac surgery: A retrospective multicenter observational analysis

Abstract

Study objective: Intraoperative hypotension is associated with perioperative morbidity. We undertook this project to describe the incidence of hypotension (defined as mean arterial pressure< 65 mmHg).

Design: Retrospective, observational study.

Setting: This study was in the intraoperative setting.

Patients: We studied 22,109 adult patients ASA 3 and 4 patients, undergoing surgeries ≥180 min, with arterialline monitoring, from January 1, 2017, to December 31, 2017.

Interventions: None.

Measurements: Our primary measurement was the number of minutes of primarily invasive mean arterial bloodpressure below 65 mmHg. Additionally, we collected patient medical history data as classified by the Elixhauser Comorbidity Enhanced ICD-9-CM/ICD-10 CM Algorithm. Additional study variables included age, gender, BMI,preoperative blood pressure, ASA physical status classification, presence of absence of vasopressor infusion(phenylephrine, norepinephrine, vasopressin), estimated blood loss, amount of PRBCs administered, and surgical procedure type, characterized by body region on the basis of primary anesthesiology Current Procedural Terminology (CPT) code.

Main results: The mean duration of MAP< 65 mmHg was 28.2 min (SD 42.6). 88% of cases had at least one hypotensive event as defined as MAP< 65 mmHg for 1 min. Across centers this varied from 83.2 to 91.6% of cases. The mean duration of hypotension ranged from 22.1 to 31.8 min.

Conclusion: There continues to be a significant burden of hypotension (defined as MAP< 65 mmHg) across our multicenter cohort of hospitals.