Department of Medicine, University of Florida, Gainesville, FL, USA; Intelligent Clinical Care Center, University of Florida, Gainesville, FL, USA.
University of Florida, Gainesville, FL, USA.
Am J Surg. 2024 Jun;232:45-53. doi: 10.1016/j.amjsurg.2024.02.001. Epub 2024 Feb 16.
There is no consensus regarding safe intraoperative blood pressure thresholds that protect against postoperative acute kidney injury (AKI). This review aims to examine the existing literature to delineate safe intraoperative hypotension (IOH) parameters to prevent postoperative AKI.
PubMed, Cochrane Central, and Web of Science were systematically searched for articles published between 2015 and 2022 relating the effects of IOH on postoperative AKI.
Our search yielded 19 articles. IOH risk thresholds ranged from <50 to <75 mmHg for mean arterial pressure (MAP) and from <70 to <100 mmHg for systolic blood pressure (SBP). MAP below 65 mmHg for over 5 min was the most cited threshold (N = 13) consistently associated with increased postoperative AKI. Greater magnitude and duration of MAP and SBP below the thresholds were generally associated with a dose-dependent increase in postoperative AKI incidence.
While a consistent definition for IOH remains elusive, the evidence suggests that MAP below 65 mmHg for over 5 min is strongly associated with postoperative AKI, with the risk increasing with the magnitude and duration of IOH.
目前对于术中血压安全阈值（可预防术后急性肾损伤）尚未达成共识。本综述旨在通过现有文献明确术中低血压（IOH）的参数，以预防术后急性肾损伤。
对 2015 年至 2022 年间发表的与 IOH 对术后急性肾损伤影响相关的文章，在 PubMed、Cochrane Central 和 Web of Science 进行了系统性检索。
搜索结果共 19 篇文章。平均动脉压（MAP）的 IOH 风险阈值范围为<50 至<75mmHg，收缩压（SBP）的 IOH 风险阈值范围为<70 至<100mmHg。MAP 持续低于 65mmHg 超过 5 分钟是最常被引用的阈值（N=13），与术后急性肾损伤发生率增加密切相关。MAP 和 SBP 低于阈值的幅度和持续时间越大，术后急性肾损伤的发生率通常呈剂量依赖性增加。
尽管 IOH 的一致定义仍难以捉摸，但证据表明，MAP 持续低于 65mmHg 超过 5 分钟与术后急性肾损伤强烈相关，风险随 IOH 的幅度和持续时间增加而增加。
