Mohseni Sana, Behnam-Roudsari Sahar, Tarbiat Mohammad, Shaker Pouyan, Shivaie Seyedmohammadshahab, Shafiee Mohammad A
Division of General Internal Medicine, Department of Medicine, Toronto General Hospital, Toronto, ON M2G 2C4, Canada.
College of Medicine, Kansas City University, Kansas City, MO, USA.
Integr Blood Press Control. 2022 Mar 19;15:23-32. doi: 10.2147/IBPC.S347395. eCollection 2022.
Perioperative hypertension, defined as increased blood pressure around the surgery, is a known risk factor for perioperative complications, including cardiovascular events. Identifying reasons associated with hypertension in each period is of great help in preventing and better managing perioperative hypertension.
The aim of the study was to explore common etiologies of hypertension during the perioperative period (pre, intra, and post-operation) in patients who underwent noncardiac surgeries in University Health Network (UHN) hospitals, Canada, from 2015 to 2020.
We retrospectively analyzed the medical records of 174 patients undergoing noncardiac surgeries who experienced perioperative hypertension. We assessed the prevalence of 10 reasons for perioperative hypertension as a whole and also each period separately according to the physicians' notes in patients' medical records. Two-way measurements ANOVA was used to determine the change of mean hypertension among patients for specific etiology.
The common etiologies of perioperative hypertension were poorly controlled hypertension (21.8%), excessive fluid therapy (19.5%), excessive vasopressor (18.4%), and medication withdrawal (13.7%). Regarding each period separately, the most common reasons were poorly controlled hypertension for pre (42.9%) and intraoperative period (22.7%) and fluid overload for the postoperative period (20.1%). Poor control of hypertension showed both within-subject statistical significance for systolic and between-subject statistical significance for diastolic blood pressure.
Poorly controlled hypertension is the most significant etiology of perioperative hypertension in patients undergoing noncardiac surgeries. Apart from poorly controlled hypertension, as a patient-related factor, iatrogenic factors such as excessive vasopressor therapy, aggressive fluid replacement and poor management of antihypertensive medications can also cause perioperative hypertension.
围手术期高血压定义为手术前后血压升高，是包括心血管事件在内的围手术期并发症的已知危险因素。确定每个时期与高血压相关的原因对预防和更好地管理围手术期高血压有很大帮助。
本研究的目的是探讨2015年至2020年在加拿大大学健康网络（UHN）医院接受非心脏手术的患者围手术期（术前、术中和术后）高血压的常见病因。
我们回顾性分析了174例接受非心脏手术且经历围手术期高血压的患者的病历。我们根据患者病历中的医生记录，评估了围手术期高血压10个原因的总体患病率以及每个时期的患病率。采用双向测量方差分析来确定特定病因患者中平均高血压的变化。
围手术期高血压的常见病因是高血压控制不佳（21.8%）、液体治疗过量（19.5%）、血管升压药过量（18.4%）和药物停用（13.7%）。分别来看每个时期，最常见的原因是术前（42.9%）和术中（22.7%）高血压控制不佳，以及术后（20.1%）液体超负荷。高血压控制不佳在收缩压方面显示出受试者内统计学意义，在舒张压方面显示出受试者间统计学意义。
高血压控制不佳是接受非心脏手术患者围手术期高血压的最主要病因。除了高血压控制不佳这一与患者相关的因素外，血管升压药治疗过量、积极补液和抗高血压药物管理不善等医源性因素也可导致围手术期高血压。
