Shingu Megumi, Mura Nariyuki, Uno Tomohiro, Oishi Ryuta, Koseki Tadashi, Sakurada Kaori
Yoshioka Hospital, Yamagata, Japan.
Department of Fundamental Nursing, Yamagata University Faculty of Medicine School of Nursing, Yamagata, Japan.
Arthrosc Sports Med Rehabil. 2021 Oct 13;3(6):e1883-e1889. doi: 10.1016/j.asmr.2021.09.003. eCollection 2021 Dec.
To investigate the relationship between visualization and blood pressure during arthroscopic rotator cuff repair (ARCR) in the beach-chair position and to clarify the optimal blood pressure to maintain good visualization during surgery.
One senior surgeon evaluated intraoperative visualization at the start of arthroscopy, at acromioplasty, at the refresh of the footprint on the greater tuberosity, at marrow vent creation in the footprint on the greater tuberosity, and at rotator cuff fixation. The evaluation grades were: 5, clear; 4, mild bleeding; 3, bleeding but operable; 2, poor visualization due to bleeding; and 1, inability to continue surgery due to massive bleeding. During ARCR, an arterial line was inserted, and blood pressure was measured continuously. The relationship between visualization and blood pressure was analyzed. Receiver operating characteristic analysis was performed with evaluation grades 5 and 4 as the good visualization group and the other evaluation grades as the poor visualization group.
Visualization assessment and systolic/diastolic blood pressure were associated at the start of arthroscopy ( = .0257/.0057), at acromioplasty ( = .0023/.0399), and at the refresh of the footprint ( = .0201/.0272). The average blood pressure of evaluation grade 5 cases was 91/50 mm Hg. The cut-off values, based on the area under the curve on receiver operating characteristic analysis, were as follows: 104/60 mm Hg (0.91-0.95) at acromioplasty; 116/70 (0.94-0.96) at the refresh of the footprint; 116/70 mm Hg (0.94-0.96) at the refresh of the footprint; and 106/58 mm Hg (0.73-0.70) at marrow vent creation.
Good visualization during ARCR in the beach-chair position was significantly associated with blood pressure. An optimal blood pressure resulting in good visualization that would not cause excessive hypotension during ARCR surgery in the beach-chair position might be a systolic blood pressure of 100 mm Hg.
III, prospective, nonrandomized, observational study.
探讨沙滩椅位关节镜下肩袖修补术（ARCR）期间视野清晰度与血压之间的关系，并明确手术中保持良好视野清晰度的最佳血压。
一名资深外科医生在关节镜检查开始时、肩峰成形术时、大结节上足迹清创时、大结节上足迹骨髓腔钻孔时以及肩袖固定时评估术中视野清晰度。评估等级为：5级，清晰；4级，轻度出血；3级，出血但可操作；2级，因出血视野不佳；1级，因大量出血无法继续手术。在ARCR期间，插入动脉导管并持续测量血压。分析视野清晰度与血压之间的关系。以评估等级5级和4级作为良好视野组，其他评估等级作为不良视野组进行受试者操作特征分析。
在关节镜检查开始时（r = 0.257/0.0057）、肩峰成形术时（r = 0.0023/0.0399）以及足迹清创时（r = 0.0201/0.0272），视野清晰度评估与收缩压/舒张压相关。评估等级为5级的病例平均血压为91/50 mmHg。根据受试者操作特征分析曲线下面积得出的截断值如下：肩峰成形术时为104/60 mmHg（0.91 - 0.95）；足迹清创时为116/70（0.94 - 0.96）；足迹清创时为116/70 mmHg（0.94 - 0.96）；骨髓腔钻孔时为106/58 mmHg（0.73 - 0.70）。
沙滩椅位ARCR期间良好的视野清晰度与血压显著相关。在沙滩椅位ARCR手术中，能带来良好视野清晰度且不会导致过度低血压的最佳血压可能是收缩压100 mmHg。
III级，前瞻性、非随机、观察性研究。
