Hanada Masatoshi, Tawara Yuichi, Miyazaki Takuro, Sato Shuntaro, Morimoto Yosuke, Oikawa Masato, Niwa Hiroshi, Eishi Kiyoyuki, Nagayasu Takeshi, Eguchi Susumu, Kozu Ryo
Cardiorespiratory Division, Department of Rehabilitation Medicine, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
Department of Cardiopulmonary Rehabilitation Science, Unit of Rehabilitation Sciences, Graduate School of Biomedical Sciences, Nagasaki University, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan.
BMC Surg. 2017 Nov 28;17(1):111. doi: 10.1186/s12893-017-0314-y.
In cardiothoracic and abdominal surgery, postoperative complications remain major clinical problems. Early mobilization has been widely practiced and is an important component in preventing complications, including orthostatic hypotension (OH) during postoperative management. We investigated cardiovascular response during early mobilization and the incidence of OH after cardiothoracic and abdominal surgery.
In this prospective observational study, we consecutively analyzed data from 495 patients who underwent elective cardiothoracic and abdominal surgery. We examined the incidence of OH, and the independent risk factors associated with OH during early mobilization after major surgery. Multivariate logistic regression was performed using various characteristics of patients to identify OH-related independent factors.
OH was observed in 191 (39%) of 495 patients. The incidence of OH in cardiac, thoracic, and abdominal groups was 39 (33%) of 119, 95 (46%) of 208, and 57 (34%) of 168 patients, respectively. Male sex (OR 1.538; p = 0.03) and epidural anesthesia (OR 2.906; p < 0.001) were independently associated with OH on multivariate analysis.
These results demonstrate that approximately 40% patients experience OH during early mobilization after cardiothoracic and abdominal surgery. Sex was identified as an independent factor for OH during early mobilization after all three types of surgeries, while epidural anesthesia was only identified after thoracic surgery. Therefore, the frequent occurrence of OH during postoperative early mobilization should be recognized.
University hospital Medical Information Network Center (UMIN-CTR) number UMIN000018632 . (Registered on 1st October, 2008).
在心胸外科和腹部外科手术中，术后并发症仍然是主要的临床问题。早期活动已被广泛应用，并且是术后管理中预防包括体位性低血压（OH）在内的并发症的重要组成部分。我们研究了心胸外科和腹部外科手术后早期活动期间的心血管反应以及OH的发生率。
在这项前瞻性观察性研究中，我们连续分析了495例行择期心胸外科和腹部外科手术患者的数据。我们检查了OH的发生率以及大手术后早期活动期间与OH相关的独立危险因素。使用患者的各种特征进行多因素逻辑回归分析以确定与OH相关的独立因素。
495例患者中有191例（39%）出现OH。心脏、胸部和腹部组中OH的发生率分别为119例中的39例（33%）、208例中的95例（46%）和168例中的57例（34%）。多因素分析显示，男性（OR 1.538；p = 0.03）和硬膜外麻醉（OR 2.906；p < 0.001）与OH独立相关。
这些结果表明，约40%的患者在心胸外科和腹部外科手术后早期活动期间出现OH。性别被确定为所有三种类型手术后早期活动期间OH的独立因素，而硬膜外麻醉仅在胸外科手术后被确定。因此，应认识到术后早期活动期间OH的频繁发生。
大学医院医学信息网络中心（UMIN-CTR）编号UMIN000018632。（于2008年10月1日注册）
