Aronson Solomon, Boisvert Denis, Lapp William
Department of Anesthesia and Critical Care, University of Chicago Medical Center, Chicago, Illinois 60637, USA.
Anesth Analg. 2002 May;94(5):1079-84, table of contents. doi: 10.1097/00000539-200205000-00005.
Isolated systolic blood pressure has not been sufficiently studied in the perioperative setting and may contribute to morbidity and mortality after coronary artery bypass grafting (CABG) surgery. Our objective was to determine the prevalence of isolated systolic hypertension among patients who had CABG surgery and to assess whether isolated systolic hypertension is associated with perioperative and postoperative in-hospital morbidity or mortality. Patients who underwent CABG were selected from a prospective epidemiological study involving 2417 patients in 24 medical centers. Patients were classified as having normal preoperative blood pressure, isolated systolic hypertension (systolic blood pressure >140 mm Hg), diastolic hypertension (diastolic blood pressure >90 mm Hg), or a combination of these. Demographic risk factors (age, sex, and ethnicity), clinical risk factors (diabetes mellitus, increased cholesterol, antihypertensive medications, history of congestive heart failure, myocardial infarction, hypertension, and neurological deficits), and behavioral risk factors (smoking and heavy drinking) were controlled for statistically. Adverse outcomes included left ventricular dysfunction, cerebral vascular dysfunction or events, renal insufficiency or failure, and all-cause mortality. Isolated systolic hypertension was found in 29.6% of patients. Unadjusted isolated systolic hypertension was associated with a 40% increased risk of adverse outcomes (odds ratio, 1.4; confidence interval, 1.1-1.7). After adjusting for other potential risk factors, the increased risk of adverse outcomes with isolated systolic hypertension was 30%. We conclude that isolated systolic hypertension is associated with a 40% increase in the likelihood of cardiovascular morbidity perioperatively in CABG patients. This increase remains present regardless of antihypertensive medications, anesthetic techniques, and other perioperative cardiovascular risk factors (e.g., age older than 60 yr or history of congestive heart failure, myocardial infarction, or diabetes).
Isolated systolic hypertension is associated with a 40% increase in the likelihood of perioperative cardiovascular morbidity in coronary artery surgery patients.
围手术期环境中，单纯收缩期血压尚未得到充分研究，其可能导致冠状动脉旁路移植术（CABG）后出现发病和死亡情况。我们的目的是确定接受CABG手术患者中单纯收缩期高血压的患病率，并评估单纯收缩期高血压是否与围手术期及术后住院期间的发病或死亡相关。接受CABG手术的患者选自一项涉及24个医疗中心2417例患者的前瞻性流行病学研究。患者被分类为术前血压正常、单纯收缩期高血压（收缩压>140 mmHg）、舒张期高血压（舒张压>90 mmHg）或这些情况的组合。对人口统计学危险因素（年龄、性别和种族）、临床危险因素（糖尿病、胆固醇升高、抗高血压药物、充血性心力衰竭病史、心肌梗死、高血压和神经功能缺损）以及行为危险因素（吸烟和大量饮酒）进行了统计学控制。不良结局包括左心室功能障碍、脑血管功能障碍或事件、肾功能不全或衰竭以及全因死亡率。29.6%的患者存在单纯收缩期高血压。未经调整的单纯收缩期高血压与不良结局风险增加40%相关（比值比，1.4；置信区间，1.1 - 1.7）。在对其他潜在危险因素进行调整后，单纯收缩期高血压导致的不良结局风险增加30%。我们得出结论，单纯收缩期高血压与CABG患者围手术期心血管发病可能性增加40%相关。无论抗高血压药物、麻醉技术以及其他围手术期心血管危险因素（如年龄大于60岁或有充血性心力衰竭、心肌梗死或糖尿病病史）如何，这种增加仍然存在。
单纯收缩期高血压与冠状动脉手术患者围手术期心血管发病可能性增加40%相关。
