Cheng Xin-Qi, Wu Hao, Zuo You-Mei, Mei Bin, Zhang Lei, Cai Yu-Zhu, Zhao Qing, Lu Xian-Fu, Liu Xue-Sheng, Gu Er-Wei
Department of Anesthesiology, First Affiliated Hospital of Anhui Medical University, 218 Jixi Road, Shushan, Hefei, 230022, Anhui, China.
J Clin Monit Comput. 2017 Apr;31(2):387-395. doi: 10.1007/s10877-016-9856-2. Epub 2016 Mar 5.
Hospital stay and mortality in high-risk patients after noncardiac surgery has been associated with a triple low anesthesia. However, the association between anesthesia-related factors and perioperative outcome after cardiac surgery remains unclear.We tested the effect of a novel triple low state: low mean arterial pressure (MAP) <65 mmHg and low bispectral index (BIS) <45 during a low target effect-site concentration (Ce) <1.5 μg ml of propofol anesthesia on postoperative duration of hospitalization and 30-day mortality in cardiac valvular patients. In this prospective observational study, univariable and multivariable logistic regression analyses were used to determine whether perioperative factors, in particular, cumulative duration of triple low state were independently associated with duration of hospitalization and 30-day mortality among patients who underwent elective valvular replacement. 489 patients were included in the final analysis. After adjusting for related covariates, cumulative duration of the triple-low state was not associated with prolonged hospitalization (multivariable odds ratio: 1.007; 95 % confidence interval 0.997-1.017; P = 0.564), but was a significant predictor of 30-day mortality (multivariable odds ratio: 1.016; 95 % confidence interval 1.002-1.031; P = 0.030). Compared to a triple-low duration of <15 min, a duration >60 min increased the 30-day mortality rate by 8 times. After adjusting for patient- and procedure-related characteristics, the cumulative duration of a triple-low state (intraoperative low MAP, low BIS, and low Ce) was associated with poorer 30-day mortality, but not with prolonged duration of hospital stay.The mortality risk was even greater when a cumulative time >60 min.
非心脏手术后高危患者的住院时间和死亡率与三重低麻醉有关。然而，心脏手术后麻醉相关因素与围手术期结局之间的关联仍不明确。我们测试了一种新型三重低状态的影响：在低目标效应室浓度（Ce）<1.5μg/ml丙泊酚麻醉期间，低平均动脉压（MAP）<65mmHg和低脑电双频指数（BIS）<45对心脏瓣膜病患者术后住院时间和30天死亡率的影响。在这项前瞻性观察研究中，采用单变量和多变量逻辑回归分析来确定围手术期因素，特别是三重低状态的累积持续时间是否与接受择期瓣膜置换术患者的住院时间和30天死亡率独立相关。最终分析纳入了489例患者。在调整相关协变量后，三重低状态的累积持续时间与住院时间延长无关（多变量优势比：1.007；95%置信区间0.997-1.017；P=0.564），但却是30天死亡率的显著预测因素（多变量优势比：1.016；95%置信区间1.002-1.031；P=0.030）。与三重低持续时间<15分钟相比，持续时间>60分钟使30天死亡率增加了8倍。在调整患者和手术相关特征后，三重低状态（术中低MAP、低BIS和低Ce）的累积持续时间与较差的30天死亡率相关，但与住院时间延长无关。当累积时间>60分钟时，死亡风险甚至更高。
