Health Services and Economics Research Unit: School of Public Health, Free University of Brussels, Brussels, Belgium.
Department of Medico-economic Information and Biostatistics, University Hospital of Liège, Liège, Belgium.
Acta Anaesthesiol Scand. 2020 Nov;64(10):1388-1396. doi: 10.1111/aas.13670. Epub 2020 Aug 17.
A wide range of thresholds define intraoperative hypotension and can be used to guide intraoperative blood pressure management. Many clinicians use the systolic blood pressure (SBP) <80 mmHg, the mean arterial pressure (MAP) <60 mmHg and the SBP percent drop from baseline (ΔSBP) >20% as alarming limits that should not be exceeded. Whether these common thresholds are valid limits that can inform clinicians on a possible increased risk of post-operative complications, particularly 30-day mortality, is currently unclear.
We performed a retrospective registry-based cohort study between January 2015 and July 2016 using departmental hospital databases and the National Death Registry. Uni- and multivariate analyses were performed to assess the association between each of these three thresholds and 30-day post-operative mortality. Six specific markers of hypotension were used.
Of 11 304 patients, 86 (0.76%) died within 30 days following surgery. All intraoperative hypotension markers for SBP < 80 mmHg and MAP < 60 mmHg were significantly associated with 30-day mortality (P < .005). Markers of ΔSBP > 20% were not significant. After adjustment for age, gender, American Society of Anesthesiologists (ASA) score, emergency status and risk related to the type of surgery, both SBP < 80 mmHg and MAP < 60 mmHg (the per cent area under the threshold marker) showed the strongest associations with 30-day mortality, with odds ratios (ORs) of 3.02 (95% confidence interval (CI) 1.81-5.07) and 3.77 (95% CI 2.25-6.31) respectively.
Commonly accepted thresholds of intraoperative hypotension, such as an SBP of 80 mmHg and an MAP of 60 mmHg, are valid alarming limits that are significantly and independently associated with 30-day mortality.
术中低血压的定义范围很广，可以用来指导术中血压管理。许多临床医生将收缩压（SBP）<80mmHg、平均动脉压（MAP）<60mmHg 和 SBP 基线下降百分比（ΔSBP）>20%作为警戒限值，不应超过这些限值。目前尚不清楚这些常见的阈值是否是有效的限制，可以告知临床医生术后并发症风险增加，特别是 30 天死亡率增加的情况。
我们使用部门医院数据库和国家死亡登记处进行了 2015 年 1 月至 2016 年 7 月期间的回顾性基于登记的队列研究。进行了单变量和多变量分析，以评估这三个阈值中的每一个与 30 天术后死亡率之间的关联。使用了 6 个特定的低血压标志物。
在 11304 名患者中，有 86 名（0.76%）在手术后 30 天内死亡。SBP<80mmHg 和 MAP<60mmHg 的所有术中低血压标志物均与 30 天死亡率显著相关（P<.005）。ΔSBP>20%的标志物则不显著。在调整年龄、性别、美国麻醉医师协会（ASA）评分、紧急状态和与手术类型相关的风险后，SBP<80mmHg 和 MAP<60mmHg（阈值标志物的百分比面积）与 30 天死亡率的相关性最强，优势比（OR）分别为 3.02（95%置信区间（CI）1.81-5.07）和 3.77（95%CI 2.25-6.31）。
术中低血压的常用阈值，如 SBP 为 80mmHg 和 MAP 为 60mmHg，是有效的警戒限值，与 30 天死亡率显著相关，且具有独立性。
