Department of Anesthesiology and Reanimation, Kirikkale University, School of Medicine, 71100 Kirikkale, Turkey.
J Clin Anesth. 2012 Sep;24(6):471-6. doi: 10.1016/j.jclinane.2012.02.007.
To assess the predictive role of heart rate (HR) recovery in the detection of intraoperative hypotension in patients undergoing noncardiac surgery.
Prospective, observational study.
Department of cardiology and operating rooms of university hospitals.
160 ASA physical status 1 and 2 patients scheduled for elective noncardiac surgery.
All patients underwent exercise stress testing. Maximum HRs and metabolic equivalent levels were recorded. Heart rate recovery at the first, second, and third minutes were calculated by subtracting HRs one, two, and three minutes into the recovery period from the maximal HR at peak exercise. A decrease in mean arterial pressure (MAP) of greater than 30% was defined as intraoperative hypotension and recorded. Patients were classified to two groups according to whether they had intraoperative hypotension.
Hypotensive episode was observed in 31 patients (19.7%) during the operation. The presence of diabetes mellitus was higher in patients with intraoperative hypotension (22.6% vs 7.1%, P = 0.019). Mean HR recovery at the first, second, and third minutes was significantly lower in the intraoperative hypotension group (P = 0.001, P = 0.004, and P = 0.031, respectively). Heart rate recovery at the first, second, and third minutes was a good predictor of intraoperative hypotension, but only HR recovery at the first minute (OR 0.82, 95% CI 0.73 to 0.92, P = 0.001) and HR recovery at the second minute (OR, 0.90; 95% CI, 0.82 to 0.98; P = 0.019) were independent predictors of intraoperative hypotension. A higher negative correlation was noted between the degree of MAP reduction and HR recovery at the first minute (r = -0.797, P = 0.001).
Abnormal preoperative exercise HR recovery predicts intraoperative hypotension in patients undergoing noncardiac surgery. Given the importance of intraoperative hypotension, preoperative use of exercise testing might be considered.
评估心率（HR）恢复在检测非心脏手术患者术中低血压中的预测作用。
前瞻性观察研究。
大学医院心内科和手术室。
160 例 ASA 身体状况 1 级和 2 级，择期行非心脏手术。
所有患者均行运动负荷试验，记录最大 HR 和代谢当量水平。通过将恢复期内的 HR 减去峰值运动时的最大 HR，计算出第 1、2 和第 3 分钟时的 HR 恢复值。术中 MAP 下降大于 30%定义为术中低血压，并记录。根据术中是否发生低血压，将患者分为两组。
术中低血压发生在 31 例（19.7%）患者中。术中低血压患者中糖尿病的发生率更高（22.6%比 7.1%，P = 0.019）。术中低血压组第 1、2 和第 3 分钟时的平均 HR 恢复值显著降低（P = 0.001、P = 0.004 和 P = 0.031）。第 1、2 和第 3 分钟时的 HR 恢复值是术中低血压的良好预测指标，但只有第 1 分钟时的 HR 恢复值（OR 0.82，95%CI 0.73 至 0.92，P = 0.001）和第 2 分钟时的 HR 恢复值（OR，0.90；95%CI，0.82 至 0.98；P = 0.019）是术中低血压的独立预测指标。MAP 降低程度与第 1 分钟时的 HR 恢复值之间存在更高的负相关性（r = -0.797，P = 0.001）。
异常的术前运动 HR 恢复可预测非心脏手术患者的术中低血压。鉴于术中低血压的重要性，术前使用运动试验可能被考虑。
