Department of Surgery, University of Florida, Gainesville, FL.
Department of Surgery, University of Florida, Gainesville, FL; Precision and Intelligent Systems in Medicine (PrismaP), University of Florida, Gainesville, FL.
Surgery. 2021 Jul;170(1):311-317. doi: 10.1016/j.surg.2021.03.054. Epub 2021 May 7.
Intraoperative hypotension during major surgery is associated with adverse health outcomes. This phenomenon represents a potentially important therapeutic target for vascular surgery patients, who may be uniquely vulnerable to intraoperative hypotension. This review summarizes current evidence regarding the impact of intraoperative hypotension on postoperative complications in patients undergoing vascular surgery, focusing on potentially modifiable procedure- and patient-specific risk factors.
A scoping review of the literature from Embase, MEDLINE, and PubMed databases was conducted from inception to December 2019 to identify articles related to the effects of intraoperative hypotension on patients undergoing vascular surgery.
Ninety-two studies met screening criteria; 9 studies met quality and inclusion criteria. Among the 9 studies that defined intraoperative hypotension objectively, there were 9 different definitions. Accordingly, the reported incidence of intraoperative hypotension ranged from 8% to 88% (when defined as a fall in systolic blood pressure of >30 mm Hg or mean arterial pressure <65). The results demonstrated that intraoperative hypotension is an independent risk factor for longer hospital length of stay, myocardial injury, acute kidney injury, postoperative mechanical ventilation, and early mortality. Vascular surgery patients with comorbid conditions that confer increased vulnerability to hypoperfusion and ischemia appear to be susceptible to the adverse effects of intraoperative hypotension.
There is no validated, consensus definition of intraoperative hypotension or other hemodynamic parameters associated with increased risk for adverse outcomes. Despite these limitations, the weight of evidence suggests that intraoperative hypotension is common and associated with major postoperative complications in vascular surgery patients.
在大型手术中出现的术中低血压与不良健康结果相关。这种现象代表了血管外科患者一个潜在的重要治疗目标，他们可能特别容易受到术中低血压的影响。本综述总结了目前关于术中低血压对血管外科患者术后并发症影响的证据，重点关注潜在可改变的手术和患者特定的危险因素。
从 Embase、MEDLINE 和 PubMed 数据库中进行了文献的范围综述，检索时间从建库至 2019 年 12 月，以确定与血管外科患者术中低血压相关的文章。
92 项研究符合筛选标准；9 项研究符合质量和纳入标准。在 9 项客观定义术中低血压的研究中，有 9 种不同的定义。因此，术中低血压的报告发生率为 8%至 88%（定义为收缩压下降>30mmHg 或平均动脉压<65mmHg）。结果表明，术中低血压是住院时间延长、心肌损伤、急性肾损伤、术后机械通气和早期死亡率的独立危险因素。合并增加灌注和缺血易感性的合并症的血管外科患者似乎容易受到术中低血压不良影响的影响。
目前尚无术中低血压或其他与不良结果风险增加相关的血流动力学参数的验证共识定义。尽管存在这些局限性，但大量证据表明，术中低血压在血管外科患者中很常见，并与主要的术后并发症相关。
