Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia.
Department of Anaesthesia and Pain Management, The Royal Melbourne Hospital, Parkville, Victoria, Australia; Department of Critical Care, University of Melbourne, Parkville, Victoria, Australia.
Br J Anaesth. 2023 Nov;131(5):813-822. doi: 10.1016/j.bja.2023.08.022. Epub 2023 Sep 29.
Postoperative hypotension is common after major surgery and is associated with patient harm. Vasopressors are commonly used to treat hypotension without clear evidence of benefit. We conducted a systematic review to better understand the use, impact, and rationale for vasopressor administration after noncardiac, non-obstetric surgery in adults.
We conducted a prospectively registered systematic review. Cochrane CENTRAL, EMBASE, MEDBASE, and MEDLINE were searched for RCTs and cohort studies of adult patients receiving vasopressors after noncardiac, non-obstetric surgery. Study quality was critically appraised by two investigators. Findings from the review were synthesised, but formal meta-analysis was not performed because of significant variability in study populations and outcomes.
A total of 3201 articles were screened, of which seven RCTs, two prospective cohort studies, and 15 retrospective cohort studies were included in the analysis (24 in total). One study was graded as high quality, two as moderate quality, and the remaining 21 as low quality. Sixteen studies relied on clinical assessment alone to decide on therapeutic interventions. Vasodilation was the most common suggested physiological disturbance. The median proportion of patients receiving vasopressors was 42% (interquartile range: 11.5-74.7%). Norepinephrine was the most common vasopressor used.
The evidence supporting the use of vasopressors to treat postoperative hypotension is limited. Future research should focus on whether vasodilatation or other physiological disturbance is driving postoperative hypotension to allow rational decision-making.
术后低血压在大手术后很常见，且与患者损害相关。血管加压素常用于治疗低血压，但缺乏明确的获益证据。我们进行了一项系统评价，以更好地了解成人非心脏非产科手术后血管加压素的使用、影响和使用理由。
我们进行了一项前瞻性注册的系统评价。检索了 Cochrane CENTRAL、EMBASE、MEDBASE 和 MEDLINE 中关于接受非心脏非产科手术后使用血管加压素的成人患者的 RCT 和队列研究。两名研究者对研究质量进行了严格评估。对评价结果进行了综合，但由于研究人群和结局存在显著差异，未进行正式的荟萃分析。
共筛选出 3201 篇文章，其中纳入了 7 项 RCT、2 项前瞻性队列研究和 15 项回顾性队列研究（共 24 项研究）。其中 1 项研究被评为高质量，2 项为中等质量，其余 21 项为低质量。16 项研究仅依靠临床评估来决定治疗干预措施。血管扩张被认为是最常见的生理紊乱。接受血管加压素治疗的患者中位数比例为 42%（四分位距：11.5-74.7%）。去甲肾上腺素是最常用的血管加压素。
支持使用血管加压素治疗术后低血压的证据有限。未来的研究应集中于血管扩张或其他生理紊乱是否导致术后低血压，以允许做出合理的决策。
