术中低血压与非心脏手术患者急性肾损伤、心肌损伤和死亡率的关系：一项荟萃分析。
Association of intra-operative hypotension with acute kidney injury, myocardial injury and mortality in non-cardiac surgery: A meta-analysis.
机构信息
Department of Anesthesiology, Chongqing University Cancer Hospital/Chongqing Cancer Institute/Chongqing Cancer Center, Chongqing City, 400030, China.
出版信息
Int J Clin Pract. 2019 Oct;73(10):e13394. doi: 10.1111/ijcp.13394. Epub 2019 Sep 11.
BACKGROUND
Intra-operative hypotension might induce poor postoperative outcomes in non-cardiac surgery, and the relationship between the level or duration of Intra-operative hypotension (IOH) and postoperative adverse events is still unclear. In this study, we performed a meta-analysis to determine how IOH could affect acute kidney injury (AKI), myocardial injury and mortality in non-cardiac surgery.
METHODS
We searched PubMed (Medline), Embase, Springer, The Cochrane Library, Ovid and Google Scholar, and retrieved the related clinical trials on intra-operative hypotension and prognosis in non-cardiac surgery.
RESULTS
Fifteen observational studies were included. The meta-analysis showed that in non-cardiac surgery, intra-operative hypotension (mean arterial pressure [MAP]) <60 mm Hg for more than 1 minute was associated with an increased risk of postoperative acute kidney injury(AKI) [1-5 minutes: odds ratio (OR) = 1.13, 95% CI (1.04, 1.23), I = 0, P = .003; 5-10 minutes: OR = 1.18, 95% CI (1.07, 1.31), I = 0, P = .001; >10 minutes: OR = 1.35, 95% CI (1.1, 1.67), I = 52.6%, P = .004] and myocardial injury [1-5 minutes: OR = 1.16, 95% CI (1.01, 1.33), I = 30.6%, P = .04; 5-10 minutes: OR = 1.34, 95% CI (1.01, 1.77), I = 70.4%, P = .046; >10 minutes: OR = 1.43, 95% CI (1.18, 1.72), I = 39.4%, P < .0001]. Intra-operative hypotension (MAP < 60 mm Hg) for 1-5 minutes was not associated with postoperative 30-day mortality [OR = 1.15, 95% CI (0.95, 1.4), I = 0, P = .154], but intra-operative hypotension (MAP < 60 mm Hg) for more than 5 min was associated with an increased risk of postoperative 30-day mortality [OR = 1.11, 95% CI (1.06, 1.17), I = 51.9%, P < .0001].
CONCLUSION
Intra-operative hypotension was associated with an increased risk of postoperative AKI, myocardial injury and 30-day mortality in non-cardiac surgery. Intra-operative MAP < 60 mm Hg more than 1 minute should be avoided.
背景
术中低血压可能导致非心脏手术的术后不良结局，术中低血压（IOH）的水平或持续时间与术后不良事件的关系仍不清楚。在这项研究中，我们进行了一项荟萃分析，以确定 IOH 如何影响非心脏手术中的急性肾损伤（AKI）、心肌损伤和死亡率。
方法
我们检索了 PubMed（Medline）、Embase、Springer、The Cochrane Library、Ovid 和 Google Scholar，并检索了与非心脏手术中术中低血压和预后相关的临床试验。
结果
纳入了 15 项观察性研究。荟萃分析显示，在非心脏手术中，MAP<60mmHg 持续 1 分钟以上与术后 AKI 风险增加相关[1-5 分钟：OR=1.13，95%CI（1.04，1.23），I=0，P=0.003；5-10 分钟：OR=1.18，95%CI（1.07，1.31），I=0，P=0.001；>10 分钟：OR=1.35，95%CI（1.1，1.67），I=52.6%，P=0.004]和心肌损伤[1-5 分钟：OR=1.16，95%CI（1.01，1.33），I=30.6%，P=0.04；5-10 分钟：OR=1.34，95%CI（1.01，1.77），I=70.4%，P=0.046；>10 分钟：OR=1.43，95%CI（1.18，1.72），I=39.4%，P<0.0001]。MAP<60mmHg 持续 1-5 分钟与术后 30 天死亡率无关[OR=1.15，95%CI（0.95，1.4），I=0，P=0.154]，但 MAP<60mmHg 持续超过 5 分钟与术后 30 天死亡率增加相关[OR=1.11，95%CI（1.06，1.17），I=51.9%，P<0.0001]。
结论
术中低血压与非心脏手术后 AKI、心肌损伤和 30 天死亡率增加相关。应避免术中 MAP<60mmHg 持续 1 分钟以上。
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