Department of Anesthesiology, Critical Care & Pain Management, Hospital for Special Surgery, Weill Cornell Medical Center, New York, NY, United States of America.
Clinical Data Core, Hospital for Special Surgery, New York, NY, United States of America.
PLoS One. 2021 Apr 1;16(4):e0248419. doi: 10.1371/journal.pone.0248419. eCollection 2021.
The use of controlled hypotension during neuraxial anesthesia for joint arthroplasty is controversial. We conducted a large institutional database analysis to assess common in-hospital complications and mortality of patients undergoing primary total hip arthroplasty (THA) under controlled hypotension and neuraxial anesthesia.
We conducted a large retrospective case control study of 11,292 patients who underwent primary THA using neuraxial anesthesia between March 2016 and May 2019 in a single institution devoted to musculoskeletal care. The degree and duration of various mean arterial pressure (MAP) thresholds were analyzed for adjusted odds ratios with composite common severe complications (in-hospital myocardial infarction, stroke, and/or acute kidney injury) as the primary outcome.
Sixty-eight patients developed common severe complications (0.60%). Patients with complications were older (median age 75.6 vs 64.0 years) and had a higher American Society of Anesthesiologists (ASA) classification (45.6% vs 17.6% ASA III). The duration of hypotension at various MAP thresholds (45 to 70 mm Hg) was not associated with increasing odds of common severe medical complications.
Controlled hypotension (ranging from 45 to 70 mmHg) for a moderate duration during neuraxial anesthesia was not associated with increased odds of common severe complications (myocardial infarction, stroke, and/or acute kidney injury) among patients receiving neuraxial anesthesia for elective THA.
在椎管内麻醉下使用控制性降压进行关节置换术存在争议。我们进行了一项大型机构数据库分析，以评估在控制性低血压和椎管内麻醉下接受初次全髋关节置换术（THA）的患者的常见住院期并发症和死亡率。
我们对 2016 年 3 月至 2019 年 5 月期间在一家专门从事肌肉骨骼护理的机构中接受椎管内麻醉的 11292 例初次 THA 患者进行了大型回顾性病例对照研究。分析了各种平均动脉压（MAP）阈值的程度和持续时间，以调整复合常见严重并发症（院内心肌梗死、中风和/或急性肾损伤）作为主要结局的比值比。
68 例患者发生常见严重并发症（0.60%）。并发症患者年龄较大（中位数年龄 75.6 岁比 64.0 岁），美国麻醉医师协会（ASA）分级较高（45.6%比 17.6%ASA III级）。在各种 MAP 阈值（45 至 70mmHg）下的低血压持续时间与常见严重医疗并发症的发生几率增加无关。
在接受椎管内麻醉的择期 THA 患者中，中等时间的控制性降压（45 至 70mmHg）与常见严重并发症（心肌梗死、中风和/或急性肾损伤）的发生几率增加无关。
