Department of Anesthesiology and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, China.
Department of Anesthesiology, Peking University Cancer Hospital, Beijing, 100083, China.
BMC Anesthesiol. 2020 Jun 29;20(1):160. doi: 10.1186/s12871-020-01062-2.
Intraoperative hypotension is associated with increased morbidity and mortality after surgery. We hypothesized that intraoperative hypotension might also be associated with worse long-term survival after cancer surgery. Herein, we analyzed the correlation between intraoperative hyper-/hypotension and overall survival after lung cancer surgery.
In this retrospective cohort study, 676 patients who received lung cancer surgery between January 1, 2006 and December 31, 2009 were reviewed. Intraoperative hyper- and hypotension were defined according to their correlation with long-term survival. The primary endpoint was overall survival. The association between episodes of intraoperative hyper-/hypotension and overall survival was analyzed with multivariable Cox proportional hazard models.
Long-term follow-ups were completed in 515 patients with a median duration of 5.2 years. The estimated 5-year survival rates were 66.5, 61.3, 56.5, and 41.2% in patients with only hypertension (systolic blood pressure > 140 mmHg for ≥5 min), with both hyper- and hypotension (systolic blood pressure < 100 mmHg for ≥5 min), with neither hyper- nor hypotension, and with only hypotension during surgery, respectively. After adjusting confounding factors, intraoperative hypotension was significantly associated with shortened overall survival (compared with patients with only intraoperative hypertension, those with both hyper- and hypotension: hazard ratio [HR]1.033, 95% confidence interval [CI] 0.709 to 1.507, p = 0.864; those with neither hyper- nor hypotension: HR 0.952, 95% CI 0.608 to 1.489, p = 0.829; those with only hypotension: HR 1.736, 95% CI 1.218 to 2.475, p = 0.002).
For patients undergoing lung cancer surgery, intraoperative hypotension, but not hypertension, was associated with shortened overall survival.
术中低血压与手术后发病率和死亡率升高有关。我们假设术中低血压也可能与癌症手术后的长期生存较差有关。在此，我们分析了术中高血压/低血压与肺癌手术后总体生存率之间的相关性。
在这项回顾性队列研究中，对 2006 年 1 月 1 日至 2009 年 12 月 31 日期间接受肺癌手术的 676 名患者进行了回顾性分析。根据与长期生存的相关性，定义术中高血压和低血压。主要终点是总生存率。采用多变量 Cox 比例风险模型分析术中高血压/低血压发作与总生存率的关系。
515 名患者完成了长期随访，中位随访时间为 5.2 年。仅高血压（收缩压>140mmHg 持续≥5 分钟）、同时存在高血压和低血压（收缩压<100mmHg 持续≥5 分钟）、既无高血压也无低血压以及仅低血压患者的 5 年估计生存率分别为 66.5%、61.3%、56.5%和 41.2%。调整混杂因素后，术中低血压与总生存时间缩短显著相关（与仅术中高血压患者相比，同时存在高血压和低血压的患者：风险比[HR]1.033，95%置信区间[CI]0.709 至 1.507，p=0.864；既无高血压也无低血压的患者：HR 0.952，95%CI 0.608 至 1.489，p=0.829；仅低血压的患者：HR 1.736，95%CI 1.218 至 2.475，p=0.002）。
对于接受肺癌手术的患者，术中低血压而不是高血压与总生存时间缩短有关。
