Ushio Masahiro, Egi Moritoki, Fujimoto Daichi, Obata Norihiko, Mizobuchi Satoshi
Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
Department of Anesthesiology, Kobe University Hospital, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe City, Hyogo 650-0017, Japan.
J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4062-4069. doi: 10.1053/j.jvca.2022.06.013. Epub 2022 Jun 19.
To study the timing, threshold, and duration of intraoperative hypotension (IOH) associated with the risk of postoperative delirium (POD).
A single-center retrospective observational study.
University teaching hospital.
A total of 503 adult patients who underwent cardiac valvular surgery that required cardiopulmonary bypass (CPB).
The authors predefined the following 4 periods: (1) during surgery, (2) pre-CPB, (3) during CPB, and (4) post-CPB, and 8 thresholds of mean arterial pressure for IOH according to every 5 mmHg between 50 mmHg and 85 mmHg. The authors calculated the cumulative duration below the 8 thresholds in each period. The primary outcome was delirium defined as a score of ≥4 for at least one Intensive Care Delirium Screening Checklist assessment during 48 h after the surgery. Among 503 patients, POD occurred in 95 patients (18.9%). There was no significant association of POD with all of the thresholds of IOH in the periods of pre-CPB, during CPB, and during surgery. However, in the post-CPB period, the patients with POD had a significantly longer cumulative duration of IOH according to all of the thresholds of mean arterial pressure. In multivariate analyses, 4 IOH thresholds in the post-CPB period were associated independently with POD: <60 mmHg (odds ratio [OR] =1.84 [95% CI 1.10-3.10]), <65 mmHg (OR = 1.72 [1.01-2.92]), <70 mmHg (OR = 1.83 [1.03-3.26]), and <75 mmHg (OR = 1.94 [1.02-3.69]).
A longer cumulative duration of IOH with the threshold between <60 and <75 mmHg that occurred after CPB was independently associated with the risk of POD.
研究与术后谵妄（POD）风险相关的术中低血压（IOH）的发生时间、阈值和持续时间。
单中心回顾性观察研究。
大学教学医院。
总共503例接受需要体外循环（CPB）的心脏瓣膜手术的成年患者。
作者预先定义了以下4个时期：（1）手术期间，（2）CPB前，（3）CPB期间，以及（4）CPB后，并且根据50 mmHg至85 mmHg之间每5 mmHg设定了8个IOH平均动脉压阈值。作者计算了每个时期低于8个阈值的累计持续时间。主要结局是谵妄，定义为术后48小时内至少一次重症监护谵妄筛查清单评估得分为≥4分。在503例患者中，95例（18.9%）发生了POD。在CPB前、CPB期间和手术期间，POD与所有IOH阈值均无显著相关性。然而，在CPB后时期，根据所有平均动脉压阈值，发生POD的患者IOH累计持续时间显著更长。在多变量分析中，CPB后时期的4个IOH阈值与POD独立相关：<60 mmHg（比值比[OR]=1.84[95%可信区间1.10 - 3.10]），<65 mmHg（OR = 1.72[1.01 - 2.92]），<70 mmHg（OR = 1.83[1.03 - 3.26]），以及<75 mmHg（OR = 1.94[1.02 - 3.69]）。
CPB后发生的IOH累计持续时间较长，阈值在<60至<75 mmHg之间，与POD风险独立相关。
