术中与术前日间静息心率的关系：一项前瞻性观察研究的二次分析。

Relationship Between Intraoperative and Preoperative Ambulatory Nighttime Heart Rates: A Secondary Analysis of a Prospective Observational Study.

机构信息

From the Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine and.

Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Anesth Analg. 2021 Aug 1;133(2):406-412. doi: 10.1213/ANE.0000000000005625.

DOI:10.1213/ANE.0000000000005625

PMID:34106905

Abstract

BACKGROUND

It remains unknown what constitutes physiologically relevant intraoperative bradycardia. Intraoperative bradycardia is usually defined using absolute heart rate thresholds, ignoring preoperative baseline heart rates. In contrast, we considered defining intraoperative bradycardia relative to preoperative ambulatory nighttime heart rate. Specifically, we hypothesized that the individual mean intraoperative heart rate is lower than the mean preoperative ambulatory nighttime heart rate. We, therefore, sought to investigate the relationship between the intraoperative and preoperative ambulatory nighttime heart rates in adults having noncardiac surgery with general anesthesia. Additionally, we sought to investigate the incidence of intraoperative bradycardia using relative versus absolute heart rate thresholds.

METHODS

We conducted a secondary analysis of a database from a prospective study including preoperative ambulatory and intraoperative heart rates in 363 patients having noncardiac surgery with general anesthesia.

RESULTS

The mean intraoperative heart rate was lower than the mean nighttime heart rate (mean difference, -9 bpm; 95% confidence interval [CI], -10 to -8 bpm; P < .001). The mean intraoperative heart rate was lower than the mean nighttime heart rate in 319 of 363 patients (88%; 95% CI, 84%-91%). The incidence of intraoperative bradycardia was 42% (95% CI, 38%-47%) when it was defined as intraoperative heart rate >30% lower than mean nighttime heart rate and 43% (95% CI, 38%-49%) when it was defined as intraoperative heart rate <45 bpm.

CONCLUSIONS

The mean intraoperative heart rate is lower than the mean nighttime heart rate in about 9 of 10 patients. Intraoperative bradycardia might thus be physiologically and clinically important. Future research needs to investigate whether there is an association between intraoperative bradycardia and postoperative outcomes.

摘要

背景

目前尚不清楚什么是生理学上相关的术中心动过缓。术中心动过缓通常使用绝对心率阈值来定义，而忽略了术前基础心率。相比之下，我们考虑将术中心动过缓定义为相对于术前日间夜间心率。具体而言，我们假设个体的平均术中心率低于术前日间夜间心率的平均值。因此，我们旨在研究成人接受全身麻醉下非心脏手术时术中与术前日间夜间心率之间的关系。此外，我们还旨在研究使用相对与绝对心率阈值的术中心动过缓发生率。

方法

我们对一项前瞻性研究的数据库进行了二次分析，该研究包括 363 例接受全身麻醉下非心脏手术患者的术前日间和术中心率。

结果

平均术中心率低于夜间平均心率（平均差值，-9 次/分；95%置信区间[CI]，-10 至-8 次/分；P <.001）。在 363 例患者中，有 319 例（88%；95%CI，84%-91%）的平均术中心率低于夜间平均心率。当定义为术中心率较夜间平均心率降低>30%时，术中心动过缓的发生率为 42%（95%CI，38%-47%）；当定义为术中心率<45 次/分时，发生率为 43%（95%CI，38%-49%）。