Department of Anaesthesiology, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
Department of Intensive Care, Amsterdam University Medical Centre, Amsterdam, the Netherlands.
BJS Open. 2021 Jan 8;5(1). doi: 10.1093/bjsopen/zraa018.
Intraoperative hypotension, with varying definitions in literature, may be associated with postoperative complications. The aim of this meta-analysis was to assess the association of intraoperative hypotension with postoperative morbidity and mortality.
MEDLINE, Embase and Cochrane databases were searched for studies published between January 1990 and August 2018. The primary endpoints were postoperative overall morbidity and mortality. Secondary endpoints were postoperative cardiac outcomes, acute kidney injury, stroke, delirium, surgical outcomes and combined outcomes. Subgroup analyses, sensitivity analyses and a meta-regression were performed to test the robustness of the results and to explore heterogeneity.
The search identified 2931 studies, of which 29 were included in the meta-analysis, consisting of 130 862 patients. Intraoperative hypotension was associated with an increased risk of morbidity (odds ratio (OR) 2.08, 95 per cent confidence interval 1.56 to 2.77) and mortality (OR 1.94, 1.32 to 2.84). In the secondary analyses, intraoperative hypotension was associated with cardiac complications (OR 2.44, 1.52 to 3.93) and acute kidney injury (OR 2.69, 1.31 to 5.55). Overall heterogeneity was high, with an I2 value of 88 per cent. When hypotension severity, outcome severity and study population variables were added to the meta-regression, heterogeneity was reduced to 50 per cent.
Intraoperative hypotension during non-cardiac surgery is associated with postoperative cardiac and renal morbidity, and mortality. A universally accepted standard definition of hypotension would facilitate further research into this topic.
术中低血压的定义在文献中各不相同，可能与术后并发症有关。本荟萃分析的目的是评估术中低血压与术后发病率和死亡率的关系。
检索 1990 年 1 月至 2018 年 8 月发表的 MEDLINE、Embase 和 Cochrane 数据库中的研究。主要终点是术后总发病率和死亡率。次要终点是术后心脏结局、急性肾损伤、中风、谵妄、手术结局和联合结局。进行亚组分析、敏感性分析和荟萃回归分析，以检验结果的稳健性并探索异质性。
搜索共确定了 2931 项研究，其中 29 项研究被纳入荟萃分析，共纳入 130862 名患者。术中低血压与发病率增加相关（比值比 (OR) 2.08，95%置信区间 1.56 至 2.77）和死亡率（OR 1.94，1.32 至 2.84）。在次要分析中，术中低血压与心脏并发症（OR 2.44，1.52 至 3.93）和急性肾损伤（OR 2.69，1.31 至 5.55）相关。总体异质性很高，I2 值为 88%。当将低血压严重程度、结局严重程度和研究人群变量添加到荟萃回归中时，异质性降低至 50%。
非心脏手术期间的术中低血压与术后心脏和肾脏发病率及死亡率相关。一个普遍接受的低血压标准定义将有助于进一步研究这一课题。
