Mascha Edward J, Yang Dongsheng, Weiss Stephanie, Sessler Daniel I
From the Departments of Quantitative Health Sciences and Outcomes Research (E.J.M., D.Y.) and Department of Outcomes Research (S.W., D.I.S.), Cleveland Clinic, Cleveland, Ohio. Current affiliation: Department of Emergency Medicine, University of Florida College of Medicine, Jacksonville, Florida (S.W.).
Anesthesiology. 2015 Jul;123(1):79-91. doi: 10.1097/ALN.0000000000000686.
Little is known about the relationship between intraoperative blood pressure variability and mortality after noncardiac surgery. Therefore, the authors tested the hypothesis that blood pressure variability, independent from absolute blood pressure, is associated with increased 30-day mortality.
Baseline and intraoperative variables plus 30-day mortality were obtained for 104,401 adults having noncardiac surgery lasting 60 min or longer. In confounder-adjusted models, the authors evaluated the associations between 30-day mortality and both time-weighted average intraoperative mean arterial pressure (TWA-MAP) and measures of intraoperative MAP variability--including generalized average real variability of MAP (ARV-MAP) and SD of MAP (SD-MAP).
Mean ± SD TWA-MAP was 84 ± 10 mmHg, and ARV-MAP was 2.5 ± 1.3 mmHg/min. TWA-MAP was strongly related to 30-day mortality, which more than tripled as TWA-MAP decreased from 80 to 50 mmHg. ARV-MAP was only marginally related to 30-day mortality (P = 0.033) after adjusting for TWA-MAP. Compared with median ARV-MAP, odds ratio (95% CI) for 30-day mortality was 1.14 (1.03 to 1.25) for low ARV-MAP (first quartile) and 0.94 (0.88 to 0.99) for high ARV-MAP (third quartile). Odds of 30-day mortality decreased as five-level categorized ARV-MAP increased (0.92; 0.87 to 0.99 for one category increase; P = 0.015). Secondarily, cumulative duration of MAP less than 50, 55, 60, 70, and 80 mmHg was associated with increased odds of 30-day mortality (all P < 0.001).
Although lower mean arterial pressure is strongly associated with mortality, lower intraoperative blood pressure variability per se is only mildly associated with postoperative mortality after noncardiac surgery.
关于非心脏手术后术中血压变异性与死亡率之间的关系，人们了解甚少。因此，作者检验了以下假设：独立于绝对血压的血压变异性与30天死亡率增加相关。
获取了104401例接受持续60分钟或更长时间非心脏手术的成年人的基线和术中变量以及30天死亡率。在混杂因素调整模型中，作者评估了30天死亡率与时间加权平均术中平均动脉压（TWA-MAP）以及术中MAP变异性测量值之间的关联，包括MAP的广义平均实际变异性（ARV-MAP）和MAP的标准差（SD-MAP）。
TWA-MAP的平均值±标准差为84±10 mmHg，ARV-MAP为2.5±1.3 mmHg/分钟。TWA-MAP与30天死亡率密切相关，当TWA-MAP从80 mmHg降至50 mmHg时，30天死亡率增加了两倍多。在调整TWA-MAP后，ARV-MAP与30天死亡率仅存在微弱关联（P = 0.033）。与ARV-MAP中位数相比，低ARV-MAP（第一四分位数）的30天死亡率比值比（95%CI）为1.14（1.03至1.25），高ARV-MAP（第三四分位数）为0.94（0.88至0.99）。随着ARV-MAP按五级分类增加，30天死亡率的几率降低（0.92；每增加一个类别为0.87至0.99；P = 0.015）。其次，MAP低于50、55、60、70和80 mmHg的累计持续时间与30天死亡率几率增加相关（所有P < 0.001）。
尽管较低的平均动脉压与死亡率密切相关，但非心脏手术后较低的术中血压变异性本身仅与术后死亡率存在轻度关联。
