连续指套式与间断振荡法动脉血压监测在麻醉诱导和非心脏手术中低血压的比较：DETECT 随机试验。

Continuous Finger-cuff versus Intermittent Oscillometric Arterial Pressure Monitoring and Hypotension during Induction of Anesthesia and Noncardiac Surgery: The DETECT Randomized Trial.

机构信息

Department of Anesthesiology, Center of Anesthesiology and Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

Institute of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

出版信息

Anesthesiology. 2023 Sep 1;139(3):298-308. doi: 10.1097/ALN.0000000000004629.

DOI:10.1097/ALN.0000000000004629

PMID:37265355

Abstract

BACKGROUND

Finger-cuff methods allow noninvasive continuous arterial pressure monitoring. This study aimed to determine whether continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery. Specifically, this study tested the hypotheses that continuous finger-cuff-compared to intermittent oscillometric-arterial pressure monitoring helps clinicians reduce the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia and the time-weighted average mean arterial pressure less than 65 mmHg during noncardiac surgery.

METHODS

In this single-center trial, 242 noncardiac surgery patients were randomized to unblinded continuous finger-cuff arterial pressure monitoring or to intermittent oscillometric arterial pressure monitoring (with blinded continuous finger-cuff arterial pressure monitoring). The first of two hierarchical primary endpoints was the area under a mean arterial pressure of 65 mmHg within 15 min after starting induction of anesthesia; the second primary endpoint was the time-weighted average mean arterial pressure less than 65 mmHg during surgery.

RESULTS

Within 15 min after starting induction of anesthesia, the median (interquartile range) area under a mean arterial pressure of 65 mmHg was 7 (0, 24) mmHg × min in 109 patients assigned to continuous finger-cuff monitoring versus 19 (0.3, 60) mmHg × min in 113 patients assigned to intermittent oscillometric monitoring (P = 0.004; estimated location shift: -6 [95% CI: -15 to -0.3] mmHg × min). During surgery, the median (interquartile range) time-weighted average mean arterial pressure less than 65 mmHg was 0.04 (0, 0.27) mmHg in 112 patients assigned to continuous finger-cuff monitoring and 0.40 (0.03, 1.74) mmHg in 115 patients assigned to intermittent oscillometric monitoring (P < 0.001; estimated location shift: -0.17 [95% CI: -0.41 to -0.05] mmHg).

CONCLUSIONS

Continuous finger-cuff arterial pressure monitoring helps clinicians reduce hypotension within 15 min after starting induction of anesthesia and during noncardiac surgery compared to intermittent oscillometric arterial pressure monitoring.

摘要

背景

指套式方法可实现非侵入性连续动脉血压监测。本研究旨在确定连续指套式动脉血压监测是否有助于临床医生在麻醉诱导后 15 分钟内以及非心脏手术期间降低低血压。具体而言，本研究检验了以下假设：与间歇式示波法动脉血压监测相比，连续指套式动脉血压监测有助于临床医生在麻醉诱导后 15 分钟内降低平均动脉压 65mmHg 的曲线下面积，以及非心脏手术期间平均动脉压小于 65mmHg 的时间加权平均值。

方法

在这项单中心试验中，242 名非心脏手术患者被随机分配至非盲连续指套式动脉血压监测或盲间歇式示波法动脉血压监测（同时进行连续指套式动脉血压监测）。两个分层主要终点中的第一个是麻醉诱导后 15 分钟内平均动脉压 65mmHg 的曲线下面积；第二个主要终点是手术期间平均动脉压小于 65mmHg 的时间加权平均值。

结果

麻醉诱导后 15 分钟内，109 例接受连续指套式监测的患者平均动脉压 65mmHg 的曲线下面积中位数（四分位距）为 7（0，24）mmHg×min，113 例接受间歇式示波法监测的患者为 19（0.3，60）mmHg×min（P=0.004；估计位置偏移：-6[95%CI：-15 至-0.3]mmHg×min）。手术期间，112 例接受连续指套式监测的患者平均动脉压小于 65mmHg 的时间加权平均值中位数（四分位距）为 0.04（0，0.27）mmHg，115 例接受间歇式示波法监测的患者为 0.40（0.03，1.74）mmHg（P<0.001；估计位置偏移：-0.17[95%CI：-0.41 至-0.05]mmHg）。