Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave-P77, Cleveland, OH, 44195, USA.
Departments of General Anesthesiology and Center for Critical Care, Anesthesiology Institute, Cleveland Clinic, Cleveland, USA.
Intensive Care Med. 2018 Jun;44(6):811-822. doi: 10.1007/s00134-018-5224-7. Epub 2018 Jun 4.
Mortality in the month following surgery is about 1000 times greater than anesthesia-related intraoperative mortality, and myocardial injury appears to be the leading cause. There is currently no known safe prophylaxis for postoperative myocardial injury, but there are strong associations among hypotension and myocardial injury, renal injury, and death. During surgery, the harm threshold is a mean arterial pressure of about 65 mmHg. In critical care units, the threshold appears to be considerably greater, perhaps 90 mmHg. The threshold triggering injury on surgical wards remains unclear but may be in between. Much of the association between hypotension and serious complications surely results from residual confounding, but sparse randomized data suggest that at least some harm can be prevented by intervening to limit hypotension. Reducing hypotension may therefore improve perioperative outcomes.
术后一个月的死亡率大约比麻醉相关术中死亡率高 1000 倍，心肌损伤似乎是主要原因。目前尚无已知的安全预防术后心肌损伤的方法，但低血压与心肌损伤、肾损伤和死亡之间存在很强的关联。手术过程中，伤害阈值约为平均动脉压 65mmHg。在重症监护病房，阈值似乎要高得多，大约 90mmHg。手术病房触发损伤的阈值尚不清楚，但可能介于两者之间。低血压与严重并发症之间的大部分关联肯定是由于残余混杂因素所致，但随机数据很少表明，通过干预限制低血压至少可以预防一些伤害。因此，减少低血压可能会改善围手术期的结果。
