Department of Intensive Care, Austin Hospital, 145 Studley Road, Heidelberg, Melbourne, VIC, 3084, Australia.
Department of Anesthesia, Austin Hospital, Melbourne, Australia.
J Clin Monit Comput. 2024 Apr;38(2):337-345. doi: 10.1007/s10877-023-01079-1. Epub 2023 Oct 13.
The impact of blood pressure targets and surgical approach (laparoscopic or open) on continuous urinary oxygenation (PuO), a validated surrogate of renal medullary PO, during general surgery, is unclear. We aimed to assess the effects of different blood pressure targets and surgical procedures on PuO. We randomized patients receiving either laparoscopic or open surgery into two mean arterial pressure (MAP) target groups: usual MAP or a high MAP. We measured PuO in real-time and analyzed it according to the type of surgery and blood pressure target. The study was retrospectively registered on the 5th of July 2023 (ACTRN12623000726651). We included 43 participants who underwent either laparoscopic (n = 20) or open surgery (n = 23). We found that PuO significantly decreased during both laparoscopic and open surgery under a usual blood pressure target (- 51% and - 49%, respectively). However, there was a sharper fall with laparoscopic surgery resulting in a higher PuO with open surgery (mean difference: 11 ± 1 mmHg higher; p < 0.001). Targeting a higher MAP resulted in a higher PuO over time during laparoscopic surgery (mean difference: 7 ± 1 mmHg, p < 0.001). In contrast, targeting a usual MAP resulted in a higher PuO during open surgery (mean difference: 7 ± 1 mmHg, p < 0.001). Surgical approach and intraoperative blood pressure targets significantly impact urinary oxygenation. Further studies with larger sample sizes are needed to confirm these findings and understand their potential clinical implications.Registration number: ACTRN12623000726651; Date of registration: 05/07/2023 (retrospectively registered).
血压目标和手术方式（腹腔镜或开放）对全身手术中连续尿氧饱和度（PuO）的影响尚不清楚，PuO 是肾髓质 PO 的验证替代物。我们旨在评估不同血压目标和手术程序对 PuO 的影响。我们将接受腹腔镜或开放手术的患者随机分为两组平均动脉压（MAP）目标组：常规 MAP 或高 MAP。我们实时测量 PuO 并根据手术类型和血压目标进行分析。该研究于 2023 年 7 月 5 日（ACTRN12623000726651）进行了回顾性登记。我们纳入了 43 名接受腹腔镜（n=20）或开放手术（n=23）的患者。我们发现，在常规血压目标下，腹腔镜和开放手术期间 PuO 均显著下降（分别下降-51%和-49%）。然而，腹腔镜手术时 PuO 下降更明显，导致开放手术时 PuO 更高（平均差异：高 11±1mmHg；p<0.001）。高 MAP 目标会导致腹腔镜手术期间 PuO 随时间升高（平均差异：高 7±1mmHg，p<0.001）。相反，常规 MAP 目标会导致开放手术时 PuO 升高（平均差异：高 7±1mmHg，p<0.001）。手术方式和术中血压目标显著影响尿氧合。需要更大样本量的进一步研究来证实这些发现并了解其潜在的临床意义。注册号：ACTRN12623000726651；登记日期：2023 年 7 月 5 日（回顾性登记）。
