在全身麻醉期间，隐匿性、未控制高血压和充分控制高血压患者的术中动脉血压波动性比较：一项前瞻性观察研究。
Comparison of intraoperative arterial blood pressure lability during general anaesthesia in masked, uncontrolled hypertensive and adequately controlled hypertensive patients: a prospective observational study.
机构信息
Department of Anaesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
出版信息
Anaesthesiol Intensive Ther. 2022;54(5):402-412. doi: 10.5114/ait.2022.123143.
INTRODUCTION
Hypertensive patients are known to have increased perioperative arterial blood pressure (BP) lability, which is related to cardiovascular events. Masked uncontrolled hypertensive patients are at high cardiovascular risk. This study aimed to compare BP lability during general anaesthesia in treated hypertensive patients with normal clinic BP, between masked uncontrolled hypertension and adequately controlled hypertension.
MATERIAL AND METHODS
Forty-three patients with apparently controlled BP were initially enrolled in this prospective observational study. Home BP was monitored and patients classified into diagnostic groups. Perioperative BP profiles were recorded from before anaesthesia induction until discharge from the recovery room. BP lability was assessed using 3 methods: (1) out-of-range probability, (2) standard deviation (SD) and variance (VAR), and (3) mean and time-averaged absolute change in BP from one measurement to the next (ARV and TARV).
RESULTS
Sixteen masked hypertensive and 21 adequately controlled hypertensive patients were analysed. The masked group had higher of BP lability [95% CI] as measured by SD than the adequately controlled group during intraoperative and postoperative periods (SBP-SD, intraoperative 17.97 [15.33, 20.60] vs. 13.528 [11.22, 15.82], P = 0.014; postoperative 10.40 [7.65, 13.16] vs. 5.49 [2.96, 8.02], P = 0.012). MAP-SD, intraoperative 12.35 [10.70, 13.99] vs. 9.66 [8.22, 11.10], P = 0.017; postoperative 7.21 [5.05, 9,38] vs. 4.06 [2.09, 6.05], P = 0.037). ARV and TARV also revealed higher intraoperative SBP lability; non-time-averaged (mmHg) 12.40 [10.43, 14.37] vs. 9.50 [7.78, 11.22], P = 0.031 and time-averaged (mmHg min-1) 2.35 [1.95, 2,74] vs. 1.82 [1.49, 2.16], P = 0.047).
CONCLUSIONS
Masked uncontrolled hypertensive patients had significantly higher BP lability in SBP and MAP during the intraoperative and immediate postoperative periods.
简介
高血压患者的围手术期动脉血压（BP）波动增加，这与心血管事件有关。未被发现的未控制高血压患者存在较高的心血管风险。本研究旨在比较接受治疗的高血压患者中，诊室血压正常的患者，在未被发现的未控制高血压和得到充分控制的高血压之间，在全身麻醉期间的 BP 波动情况。
材料和方法
最初纳入了 43 名诊室血压得到控制的患者进行前瞻性观察性研究。监测家庭血压，并根据诊断标准将患者分为诊断组。从麻醉诱导前开始记录围手术期的 BP 曲线，直到从恢复室出院。通过 3 种方法评估 BP 波动情况：（1）超出范围的概率；（2）标准差（SD）和方差（VAR）；（3）从一次测量到下一次测量的 BP 平均值和时间平均绝对变化（ARV 和 TARV）。
结果
分析了 16 例隐匿性高血压和 21 例充分控制的高血压患者。在术中及术后期间，与充分控制的高血压患者相比，隐匿性高血压患者的 BP 波动更大[SD 表示的 95%置信区间]（SBP-SD，术中 17.97[15.33, 20.60] vs. 13.528[11.22, 15.82]，P = 0.014；术后 10.40[7.65, 13.16] vs. 5.49[2.96, 8.02]，P = 0.012）。MAP-SD，术中 12.35[10.70, 13.99] vs. 9.66[8.22, 11.10]，P = 0.017；术后 7.21[5.05, 9.38] vs. 4.06[2.09, 6.05]，P = 0.037）。ARV 和 TARV 也显示术中 SBP 波动更大；非时间平均（mmHg）12.40[10.43, 14.37] vs. 9.50[7.78, 11.22]，P = 0.031 和时间平均（mmHg min-1）2.35[1.95, 2.74] vs. 1.82[1.49, 2.16]，P = 0.047）。
结论
隐匿性未控制高血压患者在术中及术后即刻期间的 SBP 和 MAP 波动明显更大。
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