Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
Br J Anaesth. 2017 Jul 1;119(1):57-64. doi: 10.1093/bja/aex127.
We hypothesized that different phases of intraoperative hypotension should be differentiated because of different underlying causative mechanisms. We defined post-induction hypotension (PIH; i.e. arterial hypotension occurring during the first 20 min after anaesthesia induction) and early intraoperative hypotension (eIOH; i.e. arterial hypotension during the first 30 min of surgery).
In this retrospective study, we included 2037 adult patients who underwent general anaesthesia. Arterial hypotension was defined as a systolic arterial blood pressure (SAP) <90 mm Hg or a need for norepinephrine infusion at > 6 µg min -1 at least once during the phases of PIH and eIOH. Multivariate logistic regression analysis was used to test for association of clinical factors with PIH and eIOH.
Independent variables significantly related to PIH were pre-induction SAP [odds ratio (OR) 0.97 (95% confidence interval 0.97-0.98)], age [OR 1.03 (1.02-1.04)], and emergency surgery [OR 1.75 (1.20-2.56); P <0.01 each]. Pre-induction SAP [OR 0.99 (0.98-0.99), P <0.01], age [OR 1.02 (1.02-1.03), P <0.01], emergency surgery [OR 1.83 (1.28-2.62), P <0.01], supplementary administration of spinal or epidural anaesthetic techniques [OR 3.57 (2.41-5.29), P <0.01], male sex [OR 1.41 (1.12-1.79), P <0.01], and ASA physical status IV [OR 2.18 (1.19-3.99), P =0.01] were significantly related to eIOH.
We identified clinical factors associated with PIH and eIOH. The use of these factors to estimate the risk of PIH and eIOH might allow the avoidance or timely treatment of hypotensive episodes during general anaesthesia.
我们假设术中低血压的不同阶段应该加以区分，因为它们有不同的潜在致病机制。我们定义诱导后低血压（PIH，即麻醉诱导后 20 分钟内发生的动脉低血压）和早期术中低血压（eIOH，即手术最初 30 分钟内发生的动脉低血压）。
在这项回顾性研究中，我们纳入了 2037 名接受全身麻醉的成年患者。动脉低血压定义为收缩压（SAP）<90mmHg 或至少在 PIH 和 eIOH 期间需要输注去甲肾上腺素>6μg min -1。使用多变量逻辑回归分析来测试临床因素与 PIH 和 eIOH 的相关性。
与 PIH 显著相关的独立变量是诱导前 SAP[比值比（OR）0.97（95%置信区间 0.97-0.98）]、年龄[OR 1.03（1.02-1.04）]和急症手术[OR 1.75（1.20-2.56）；P<0.01]。诱导前 SAP[OR 0.99（0.98-0.99），P<0.01]、年龄[OR 1.02（1.02-1.03），P<0.01]、急症手术[OR 1.83（1.28-2.62），P<0.01]、补充应用脊髓或硬膜外麻醉技术[OR 3.57（2.41-5.29），P<0.01]、男性[OR 1.41（1.12-1.79），P<0.01]和美国麻醉医师协会（ASA）身体状况Ⅳ级[OR 2.18（1.19-3.99），P=0.01]与 eIOH 显著相关。
我们确定了与 PIH 和 eIOH 相关的临床因素。使用这些因素来估计 PIH 和 eIOH 的风险可能允许在全身麻醉期间避免或及时治疗低血压发作。
