Levin M A, Fischer G W, Lin H-M, McCormick P J, Krol M, Reich D L
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA Department of Cardiothoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Br J Anaesth. 2015 Nov;115(5):716-26. doi: 10.1093/bja/aev293. Epub 2015 Sep 22.
Arterial blood pressure lability, defined as rapid changes in arterial blood pressure, occurs commonly during anaesthesia. It is believed that hypertensive patients exhibit more lability during surgery and that lability is associated with poorer outcomes. Neither association has been rigorously tested. We hypothesized that hypertensive patients have more blood pressure lability and that increased lability is associated with increased 30 day mortality.
This was a retrospective single-centre study of surgical patients from July 2008 to December 2012. Intraoperative data were extracted from the electronic anaesthesia record. Lability was calculated as the modulus of the percentage change in mean arterial pressure between consecutive 5 min intervals. The number of episodes of lability >10% was tabulated. Multivariate logistic regression was performed to determine the association between lability and 30 day mortality using derivation and validation cohorts.
Inclusion criteria were met by 52 919 subjects. Of the derivation cohort, 53% of subjects were hypertensive and 42% used an antihypertensive medication. The median number of episodes of lability >10% was 9 (interquartile range 5-14) per patient. Hypertensive subjects demonstrated more lability than normotensive patients, 10 (5-15) compared with 8 (5-12), P<0.0001. In subjects taking no antihypertensive medication, lability >10% was associated with decreased 30 day mortality, odds ratio (OR) per episode 0.95 [95% confidence interval (CI) 0.92-0.97], P<0.0001. This result was confirmed in the validation cohort, OR 0.96 (95% CI 0.93-0.99), P=0.01, and in hypertensive patients taking no antihypertensive medication, OR 0.96 (95% CI 0.93-0.99), P=0.002. Use of any antihypertensive medication class reduced this effect.
Intraoperative arterial blood pressure lability occurs more often in hypertensive patients. Contrary to common belief, increased lability was associated with decreased 30 day mortality.
动脉血压波动，定义为动脉血压的快速变化，在麻醉期间普遍发生。据信高血压患者在手术期间表现出更多的血压波动，且血压波动与较差的预后相关。但这两种关联均未得到严格验证。我们假设高血压患者有更多的血压波动，且波动增加与30天死亡率增加相关。
这是一项对2008年7月至2012年12月手术患者的回顾性单中心研究。术中数据从电子麻醉记录中提取。血压波动计算为连续5分钟间隔内平均动脉压变化百分比的模。统计血压波动>10%的发作次数。使用推导队列和验证队列进行多因素逻辑回归，以确定血压波动与30天死亡率之间的关联。
52919名受试者符合纳入标准。在推导队列中，53%的受试者为高血压患者，42%使用抗高血压药物。每位患者血压波动>10%的发作次数中位数为9次（四分位间距5 - 14）。高血压受试者的血压波动比血压正常患者更多，分别为10次（5 - 15）和8次（5 - 12），P<0.0001。在未服用抗高血压药物的受试者中，血压波动>10%与30天死亡率降低相关，每次发作的比值比（OR）为0.95[95%置信区间（CI）0.92 - 0.97]，P<0.0001。这一结果在验证队列中得到证实，OR为0.96（95%CI 0.93 - 0.99），P = 0.01，在未服用抗高血压药物的高血压患者中，OR为0.96（95%CI 0.93 - 0.99），P = 0.002。使用任何抗高血压药物类别均可降低这种效应。
术中动脉血压波动在高血压患者中更常发生。与普遍看法相反，血压波动增加与30天死亡率降低相关。
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