成年患者非心脏手术期间术中低血压与严重术后并发症的关联：一项系统评价和荟萃分析。
Association of intraoperative hypotension and severe postoperative complications during non-cardiac surgery in adult patients: A systematic review and meta-analysis.
作者信息
Cai Jianghui, Tang Mi, Wu Huaye, Yuan Jing, Liang Hua, Wu Xuan, Xing Shasha, Yang Xiao, Duan Xiao-Dong
机构信息
Department of Pharmacy, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, China.
出版信息
Heliyon. 2023 May 1;9(5):e15997. doi: 10.1016/j.heliyon.2023.e15997. eCollection 2023 May.
BACKGROUND
Intraoperative hypotension (IOH) is a common side effect of non-cardiac surgery that might induce poor postoperative outcomes. The relationship between the IOH and severe postoperative complications is still unclear. Thus, we summarized the existing literature to evaluate whether IOH contributes to developing severe postoperative complications during non-cardiac surgery.
METHODS
We conducted a comprehensive search of PubMed, Embase, Cochrane Library, Web of Science, and the CBM from inception to 15 September 2022. The primary outcomes were 30-day mortality, acute kidney injury (AKI), major adverse cardiac events (myocardial injury or myocardial infarction), postoperative cognitive dysfunction (POCD), and postoperative delirium (POD). Secondary outcomes included surgical-site infection (SSI), stroke, and 1-year mortality.
RESULTS
72 studies (3 randomized; 69 non-randomized) were included in this study. Low-quality evidence showed IOH resulted in an increased risk of 30-day mortality (OR, 1.85; 95% CI, 1.30-2.64; P < .001), AKI (OR, 2.69; 95% CI, 2.15-3.37; P < .001), and stroke (OR, 1.33; 95% CI, 1.21-1.46; P < .001) after non-cardiac surgery than non-IOH. Very low-quality evidence showed IOH was associated with a higher risk of myocardial injury (OR, 2.00; 95% CI, 1.17-3.43; P = .01), myocardial infarction (OR, 2.11; 95% CI, 1.41-3.16; P < .001), and POD (OR, 2.27; 95% CI, 1.53-3.38; P < .001). Very low-quality evidence showed IOH have a similar incidence of POCD (OR, 2.82; 95% CI, 0.83-9.50; P = .10) and 1-year-mortality (OR, 1.66; 95% CI, 0.65-4.20; P = .29) compared with non-IOH in non-cardiac surgery.
CONCLUSION
Our results suggest IOH was associated with an increased risk of severe postoperative complications after non-cardiac surgery than non-IOH. IOH is a potentially avoidable hazard that should be closely monitored during non-cardiac surgery.
背景
术中低血压（IOH）是非心脏手术常见的副作用，可能导致术后不良结局。IOH与严重术后并发症之间的关系仍不明确。因此，我们总结现有文献，以评估IOH是否会促使非心脏手术期间发生严重术后并发症。
方法
我们对PubMed、Embase、Cochrane图书馆、Web of Science和中国生物医学文献数据库进行了全面检索，检索时间从建库至2022年9月15日。主要结局包括30天死亡率、急性肾损伤（AKI）、主要不良心脏事件（心肌损伤或心肌梗死）、术后认知功能障碍（POCD）和术后谵妄（POD）。次要结局包括手术部位感染（SSI）、中风和1年死亡率。
结果
本研究纳入了72项研究（3项随机对照研究；69项非随机对照研究）。低质量证据表明，与非IOH相比，IOH会增加非心脏手术后30天死亡率（OR=1.85；95%CI：1.30-2.64；P<.001）、AKI（OR=2.69；95%CI：2.15-3.37；P<.001）和中风（OR=1.33；95%CI：1.21-1.46；P<.001）的风险。极低质量证据表明，IOH与心肌损伤（OR=2.00；95%CI：1.17-3.43；P=0.01）、心肌梗死（OR=2.11；95%CI：1.41-3.16；P<.001）和POD（OR=2.27；95%CI：1.53-3.38；P<.001）的较高风险相关。极低质量证据表明，与非心脏手术中的非IOH相比，IOH的POCD发生率（OR=2.82；95%CI：0.83-9.50；P=0.10）和1年死亡率（OR=1.66；95%CI：0.65-4.20；P=0.29）相似。
结论
我们的结果表明，与非IOH相比，IOH与非心脏手术后严重术后并发症的风险增加相关。IOH是一种潜在可避免的危险因素，在非心脏手术期间应密切监测。
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