Michelet Daphné, Arslan Ozkan, Hilly Julie, Mangalsuren Nyamjargal, Brasher Christopher, Grace Robert, Bonnard Arnaud, Malbezin Serge, Nivoche Yves, Dahmani Souhayl
Department of Anesthesia, Intensive Care and Pain Management, AP-HP, Robert Debré University Hospital, Paris, France.
Paris Diderot University (Paris VII), Pres Paris Sorbonne Cité, Paris, France.
Paediatr Anaesth. 2015 Jul;25(7):681-8. doi: 10.1111/pan.12671. Epub 2015 Apr 30.
Intraoperative hypotension has been linked to poor postoperative neurological outcomes. However, the definition of hypotension remains controversial in children. We sought to determine arterial blood pressure threshold values associated with cerebral desaturation in infants.
After ethics committee approval, infants younger than 3 months were included in this prospective observational study. Cerebral saturation was assessed using near-infrared spectroscopy. The primary goal of the study was to determine percentage reductions in intraoperative systolic blood pressure (SBP) and mean blood pressure (MBP) associated with decreases in cerebral blood oxygen saturation of >20%, when compared to baseline. Analyses were performed using a bootstrap receiving operator characteristic (ROC) curves with determination of the gray zone.
Sixty patients were recruited and 960 measurement points were recorded. Fifty-nine data points (6.1%) recorded cerebral desaturation of >20% when compared to baseline. The areas under the ROC curves were 0.79 (0.74-0.84) and 0.67 (0.6-0.75) for percentage decreases in SBP and MBP, respectively. Gray zone values with false-positive and negative rates <10% were SBP decreases of 20.5% and 37.5%, respectively, and MBP decreases of 15.5% and 44.5%, respectively.
Our results indicate that falls in noninvasive systolic blood pressure of <20% from baseline are associated with a <10% chance of cerebral desaturation in neonates and infants <3 months of age undergoing noncardiac surgery. As such, maintaining systolic blood pressure above this threshold value appears a valid clinical target.
术中低血压与术后不良神经学结局相关。然而，儿童低血压的定义仍存在争议。我们试图确定与婴儿脑氧饱和度降低相关的动脉血压阈值。
经伦理委员会批准后，本前瞻性观察性研究纳入了3个月以下的婴儿。使用近红外光谱法评估脑氧饱和度。该研究的主要目的是确定与基线相比，术中收缩压（SBP）和平均血压（MBP）降低百分比与脑血氧饱和度降低>20%相关时的情况。使用自抽样接受者操作特征（ROC）曲线并确定灰色区域进行分析。
招募了60名患者并记录了960个测量点。与基线相比，59个数据点（6.1%）记录到脑氧饱和度降低>20%。SBP和MBP降低百分比的ROC曲线下面积分别为0.79（0.74 - 0.84）和0.67（0.6 - 0.75）。假阳性和假阴性率<10%的灰色区域值分别为SBP降低20.5%和37.5%，MBP降低15.5%和44.5%。
我们的结果表明，在接受非心脏手术的3个月以下新生儿和婴儿中，无创收缩压较基线下降<20%与脑氧饱和度降低的几率<10%相关。因此，将收缩压维持在该阈值以上似乎是一个有效的临床目标。
