Chen B, Pang Q-Y, An R, Liu H-L
Department of Anesthesiology, Chongqing University Cancer Hospital, Chongqing, China.
Eur Rev Med Pharmacol Sci. 2021 Nov;25(22):7044-7050. doi: 10.26355/eurrev_202111_27255.
Clinical evidence has proved that postinduction hypotension (PIH) is very prevalent in surgical patients undergoing general anesthesia, and commonly develops within 20 min after the induction of general anesthesia. However, the risk factors for PIH are not clear till now, therefore, a systematic review of current evidence was conducted.
PubMed, Embase, Cochrane library, and Web of Science were searched for articles published in English up to June 2021. The following search items were used: postinduction, postintubation, propofol induction, anesthesia induction, general anesthesia induction, hypotension, risk factor, general anesthesia, surgery. The articles were screened using the inclusion and exclusion criteria, and the data from included studies were extracted and analyzed.
Twelve studies were included. Seven studies reported the association between age and PIH, and six showed age was a risk factor. Five or three studies reported the association between mean arterial pressure (MAP) and PIH or between systolic blood pressure (SBP) and PIH, but the results were conflicting. Results from two studies regarding gender and PIH were conflicting. Two studies reported that weight was negatively correlated with PIH. Low baseline blood volume, emergency operation, long-term intake of the angiotensin converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were risk factors for PIH. One study showed that ASA III-V, propofol induction, and increasing fentanyl dosage were risk factors for PIH.
Aging, ASA III-V, emergency operation, low baseline blood volume, long-term intake of ACEI/ARB, propofol induction, and increasing fentanyl dosage are potential risk factors for PIH, while body weight gain is a protective factor. Based on the current evidence, it is difficult to determine whether baseline blood pressure or gender is associated with the development of PIH.
临床证据已证明，诱导后低血压（PIH）在接受全身麻醉的外科手术患者中非常普遍，且通常在全身麻醉诱导后20分钟内出现。然而，目前PIH的危险因素尚不清楚，因此，对现有证据进行了系统综述。
检索了截至2021年6月在PubMed、Embase、Cochrane图书馆和Web of Science上发表的英文文章。使用了以下检索词：诱导后、插管后、丙泊酚诱导、麻醉诱导、全身麻醉诱导、低血压、危险因素、全身麻醉、手术。根据纳入和排除标准对文章进行筛选，并提取和分析纳入研究的数据。
纳入12项研究。7项研究报告了年龄与PIH之间的关联，6项研究表明年龄是一个危险因素。5项或3项研究报告了平均动脉压（MAP）与PIH之间或收缩压（SBP）与PIH之间的关联，但结果相互矛盾。两项关于性别与PIH的研究结果相互矛盾。两项研究报告体重与PIH呈负相关。低基线血容量、急诊手术、长期服用血管紧张素转换酶抑制剂（ACEI）/血管紧张素受体阻滞剂（ARB）是PIH的危险因素。一项研究表明，美国麻醉医师协会（ASA）Ⅲ-Ⅴ级、丙泊酚诱导和芬太尼剂量增加是PIH的危险因素。
年龄增长、ASAⅢ-Ⅴ级、急诊手术、低基线血容量、长期服用ACEI/ARB、丙泊酚诱导和芬太尼剂量增加是PIH的潜在危险因素，而体重增加是一个保护因素。基于目前的证据，很难确定基线血压或性别是否与PIH的发生有关。
