Department of Anesthesiology, The University of California, USA.
J Neurosurg Anesthesiol. 2013 Apr;25(2):154-61. doi: 10.1097/ANA.0b013e31827a0151.
Because decisions as to what range of intraoperative blood pressure (BP) is consistent with cerebral well-being are often made in reference to "baseline BP," we sought to determine whether day-of-surgery BPs accurately reflect baseline BP, as defined by ambulatory clinic BPs over the preceding 7 months.
Consecutive patients (n=101) who were severely hypertensive (Severe-HTN), systolic (S)>160 mm Hg, or diastolic (D)>100 at first operating room BP (1st OR-BP) were identified retrospectively. Two additional groups were formed from patients whose 1st OR-BP was moderately hypertensive (Mod-HTN, systolic BP=140 to 159 and/or diastolic BP=90 to 99; and normotensive, SBP=110 to 139 and DBP<89). 1st OR-BP was compared with: (1) BP before transfer to the OR (Pre-OR-BP); (2) BP during ambulatory evaluation 1 to 30 days preoperatively (Preop-Eval-BP); and (3) Baseline-BP (average of at least 3 ambulatory clinic BPs during the preceding 7 months). Comorbidity data were collected.
For Severe-HTNs, 1st OR-BP, and Pre-OR-BP (expressed as mean arterial pressure) exceeded Baseline-BP by 16.4±11.6 (SD) and 5.2±11.6 (SD), respectively (P<0.05). Preop-Eval-BP was not different from Baseline-BP. For Mod-HTNs, 1st OR-BP exceeded Baseline-BP by 7.4±8.1 (SD) (P<0.05). But, Pre-OR-BP and Preop-Eval-BP did not differ from Baseline-BP. Among normotensives, 1st OR-BP was not different from Preop-Eval-BP or Baseline-BP. Hypertension, number of antihypertensive medications, vascular diagnoses (peripheral, coronary, cerebral), diabetes, and renal disease were more common in the hypertensive groups. The number of antihypertensive medications, a history of coronary disease, and insulin administration were predictors of an increase in 1st OR-BP over Baseline-BP.
For most patients whose 1st OR-BP is hypertensive, that BP is greater than ambulatory clinic BPs recorded during the preceding 7 months. For most patients with Severe-HTN at 1st OR-BP, day-of-surgery BPs overestimate Baseline-BP and reference to prehospitalization BPs is advisable. When 1st OR-BP is normotensive, that BP usually reflects Baseline-BP.
由于术中血压（BP）范围与脑健康一致的决策通常参考“基础 BP”，因此我们试图确定手术当天的 BP 是否准确反映了过去 7 个月门诊诊所 BP 的基础 BP。
回顾性确定首次手术室 BP（1st OR-BP）严重高血压（Severe-HTN）、收缩压（S）>160mmHg 或舒张压（D）>100mmHg 的连续患者（n=101）。从收缩压 140 至 159mmHg 和/或舒张压 90 至 99mmHg 的中度高血压（Mod-HTN）和收缩压 110 至 139mmHg 且舒张压<89mmHg 的正常血压患者中形成了另外两个组。将 1st OR-BP 与以下各项进行比较：（1）转移到手术室前的 BP（Pre-OR-BP）；（2）术前 1 至 30 天门诊评估期间的 BP（Preop-Eval-BP）；和（3）基础 BP（过去 7 个月至少 3 次门诊诊所 BP 的平均值）。收集合并症数据。
对于严重高血压患者，1st OR-BP 和 Pre-OR-BP（表示为平均动脉压）比基础 BP 高 16.4±11.6（SD）和 5.2±11.6（SD），分别为（P<0.05）。Preop-Eval-BP 与基础 BP 无差异。对于中度高血压患者，1st OR-BP 比基础 BP 高 7.4±8.1（SD）（P<0.05）。但是，Pre-OR-BP 和 Preop-Eval-BP 与基础 BP 无差异。对于正常血压患者，1st OR-BP 与 Preop-Eval-BP 或基础 BP 无差异。高血压、降压药物数量、血管疾病（外周、冠状动脉、大脑）、糖尿病和肾脏疾病在高血压组中更为常见。降压药物数量、冠心病病史和胰岛素给药是 1st OR-BP 比基础 BP 升高的预测因素。
对于大多数 1st OR-BP 为高血压的患者，该 BP 高于过去 7 个月记录的门诊诊所 BP。对于大多数 1st OR-BP 为严重高血压的患者，手术当天的 BP 高估了基础 BP，建议参考住院前的 BP。当 1st OR-BP 为正常血压时，该 BP 通常反映基础 BP。
