From the Department of Anesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands.
Anesthesiology. 2020 Sep;133(3):510-522. doi: 10.1097/ALN.0000000000003368.
Intraoperative hypotension has been associated with postoperative morbidity and early mortality. Postoperative hypotension, however, has been less studied. This study examines postoperative hypotension, hypothesizing that both the degree of hypotension severity and longer durations would be associated with myocardial injury.
This single-center observational cohort was comprised of 1,710 patients aged 60 yr or more undergoing intermediate- to high-risk noncardiac surgery. Frequent sampling of hemodynamic monitoring on a postoperative high-dependency ward during the first 24 h after surgery was recorded. Multiple mean arterial pressure (MAP) absolute thresholds (50 to 75 mmHg) were used to define hypotension characterized by cumulative minutes, duration, area, and time-weighted-average under MAP. Zero time spent under a threshold was used as the reference group. The primary outcome was myocardial injury (a peak high-sensitive troponin T measurement 50 ng/l or greater) during the first 3 postoperative days.
Postoperative hypotension was common, e.g., 2 cumulative hours below a threshold of 60 mmHg occurred in 144 (8%) patients while 4 h less than 75 mmHg occurred in 824 (48%) patients. Patients with myocardial injury had higher prolonged exposures for all characterizations. After adjusting for confounders, postoperative duration below a threshold of 75 mmHg for more than 635 min was associated with myocardial injury (adjusted odds ratio, 2.68; 95% CI, 1.46 to 5.07, P = 0.002). Comparing multiple thresholds, cumulative durations of 2 to 4 h below a MAP threshold of 60 mmHg (adjusted odds ratio, 3.26; 95% CI, 1.57 to 6.48, P = 0.001) and durations of more than 4 h less than 65 mmHg (adjusted odds ratio, 2.98; 95% CI, 1.78 to 4.98, P < 0.001) and 70 mmHg (adjusted odds ratio, 2.18; 95% CI, 1.37 to 3.51, P < 0.001) were also associated with myocardial injury. Associations remained significant after adjusting for intraoperative hypotension, which independently was not associated with myocardial injury.
In this study, postoperative hypotension was common and was independently associated with myocardial injury.
术中低血压与术后发病率和早期死亡率有关。然而，术后低血压的研究较少。本研究检查了术后低血压，假设低血压的严重程度和持续时间都与心肌损伤有关。
这是一项单中心观察性队列研究，纳入了 1710 名年龄在 60 岁及以上、接受中高危非心脏手术的患者。记录了术后在高依赖病房的第一个 24 小时内频繁的血流动力学监测。使用多个平均动脉压（MAP）绝对阈值（50 至 75mmHg）来定义低血压，特征为累积分钟、持续时间、面积和 MAP 下时间加权平均值。零时间低于阈值作为参考组。主要结果是术后 3 天内发生心肌损伤（高敏肌钙蛋白 T 峰值测量值大于等于 50ng/L）。
术后低血压很常见，例如，144 名患者（8%）有 2 个小时的累计时间低于 60mmHg 的阈值，824 名患者（48%）有 4 小时的时间低于 75mmHg 的阈值。发生心肌损伤的患者有更高的所有特征的长时间暴露。在调整混杂因素后，术后持续时间超过 635 分钟低于 75mmHg 的阈值与心肌损伤相关（调整后的优势比，2.68；95%CI，1.46 至 5.07，P=0.002）。比较多个阈值，MAP 低于 60mmHg 的阈值持续 2 至 4 小时（调整后的优势比，3.26；95%CI，1.57 至 6.48，P=0.001）和持续时间超过 4 小时低于 65mmHg（调整后的优势比，2.98；95%CI，1.78 至 4.98，P<0.001）和 70mmHg（调整后的优势比，2.18；95%CI，1.37 至 3.51，P<0.001）也与心肌损伤相关。在调整术中低血压后，这些关联仍然显著，而术中低血压与心肌损伤无关。
在这项研究中，术后低血压很常见，并且与心肌损伤独立相关。
