From the Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, EC1 M 6BQ (Abbott, Pearse, Ackland), and Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK (Howell).
Eur J Anaesthesiol. 2021 May 1;38(5):468-476. doi: 10.1097/EJA.0000000000001443.
Control of blood pressure remains a key goal of peri-operative care, because hypotension is associated with adverse outcomes after surgery.
We explored whether increased vigilance afforded by intra-arterial blood pressure monitoring may be associated with less morbidity after surgery.
A prospective observational cohort study.
Four UK secondary care hospitals.
A total of 4342 patients ≥45 years who underwent noncardiac surgery.
We compared outcome of patients who received peri-operative intra-arterial blood pressure monitoring with those whose blood pressure was measured noninvasively.
The primary outcome was peri-operative myocardial injury (high-sensitivity troponin-T ≥ 15 ng l-1 within 72 h after surgery), compared between patients who received intra-arterial versus noninvasive blood pressure monitoring. Secondary outcomes were morbidity within 72 h of surgery (postoperative morbidity survey), and vasopressor and fluid therapy. Multivariable logistic regression analysis explored associations between morbidity and age, sex, location of postoperative care, mode of blood pressure/haemodynamic monitoring and Revised Cardiac Risk Index.
Intra-arterial monitoring was used in 1137/4342 (26.2%) patients. Myocardial injury occurred in 440/1137 (38.7%) patients with intra-arterial monitoring compared with 824/3205 (25.7%) with noninvasive monitoring [OR 1.82 (95% CI 1.58 to 2.11), P < 0.001]. Intra-arterial monitoring remained associated with myocardial injury when adjusted for potentially confounding variables [adjusted OR 1.56 (1.29 to 1.89), P < 0.001). The results were similar for planned ICU versus ward postoperative care.
Intra-arterial monitoring is associated with greater risk of morbidity after noncardiac surgery, after controlling for surgical and patient factors. These data provide useful insights into the design of a definitive monitoring trial.
控制血压仍然是围手术期护理的一个关键目标，因为低血压与手术后的不良结果有关。
我们探讨了动脉内血压监测所提供的更高警惕性是否与手术后的发病率降低有关。
前瞻性观察队列研究。
英国四家二级保健医院。
共纳入 4342 名年龄≥45 岁的非心脏手术患者。
我们比较了接受围手术期动脉内血压监测的患者与接受非侵入性血压监测的患者的结果。
主要结局是围手术期心肌损伤（手术后 72 小时内高敏肌钙蛋白 T≥15ng l-1），比较接受动脉内与非侵入性血压监测的患者之间的差异。次要结局是手术后 72 小时内的发病率（术后发病率调查）以及血管加压药和液体治疗。多变量逻辑回归分析探讨了发病率与年龄、性别、术后护理地点、血压/血流动力学监测方式和修订后的心脏风险指数之间的关系。
在 4342 例患者中，有 1137 例（26.2%）接受了动脉内监测。与接受非侵入性监测的 3205 例患者中的 824 例（25.7%）相比，接受动脉内监测的患者中有 440 例（38.7%）发生心肌损伤[比值比 1.82（95%可信区间 1.58 至 2.11），P<0.001]。在校正了可能的混杂因素后，动脉内监测仍与心肌损伤相关[校正比值比 1.56（1.29 至 1.89），P<0.001]。对于计划的 ICU 与病房术后护理，结果相似。
在控制手术和患者因素后，动脉内监测与非心脏手术后发病率的增加相关。这些数据为设计一项明确的监测试验提供了有用的见解。
