围手术期低血压亚型的探索：一项前瞻性、单队列、观察性试点研究。
The exploration of perioperative hypotension subtypes: a prospective, single cohort, observational pilot study.
作者信息
Zhao Xu, Zhang Yuanjia, Kou Mengjia, Wang Zhongxing, He Qiulan, Wen Zhishuang, Chen Jingyuan, Song Yiyan, Wu Shihui, Huang Chanyan, Huang Wenqi
机构信息
Department of Anesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
出版信息
Front Med (Lausanne). 2024 Jun 17;11:1358067. doi: 10.3389/fmed.2024.1358067. eCollection 2024.
BACKGROUND
Hypotension is a risk factor for postoperative complications, but evidence from randomized trials does not support that a higher blood pressure target always leads to optimized outcomes. The heterogeneity of underlying hemodynamics during hypotension may contribute to these contradictory results. Exploring the subtypes of hypotension can enable optimal management of intraoperative hypotension.
METHODS
This is a prospective, observational pilot study. Patients who were ≥ 45 years old and scheduled to undergo moderate-to-high-risk noncardiac surgery were enrolled in this study. The primary objective of this pilot study was to investigate the frequency and distribution of perioperative hypotension and its subtypes (hypotension with or without cardiac output reduction). The exposure of hypotension and its subtypes in patients with and without myocardial or acute kidney injury were also explored.
RESULTS
Sixty patients were included in the analysis. 83% (50/60) of the patients experienced perioperative hypotension. The median duration of hypotension for each patient was 8.0 [interquartile range, 3.1-23.3] minutes. Reduced cardiac output was present during 77% of the hypotension duration. Patients suffering from postoperative myocardial or acute kidney injury displayed longer duration and more extensive exposure in all hypotension subtypes. However, the percentage of different hypotension subtypes did not differ in patients with or without postoperative myocardial or acute kidney injury.
CONCLUSION
Perioperative hypotension was frequently accompanied by cardiac output reduction in moderate-to-high-risk noncardiac surgical patients. However, due to the pilot nature of this study, the relationship between hypotension subtypes and postoperative myocardial or acute kidney injury still needs further exploration.
CLINICAL TRIAL REGISTRATION
https://www.chictr.org.cn/showprojEN.html?proj=134260, CTR2200055929.
背景
低血压是术后并发症的一个危险因素，但随机试验的证据并不支持较高的血压目标总能带来最佳结果。低血压期间潜在血流动力学的异质性可能导致了这些相互矛盾的结果。探索低血压的亚型有助于对术中低血压进行优化管理。
方法
这是一项前瞻性观察性试点研究。纳入年龄≥45岁且计划接受中高风险非心脏手术的患者。这项试点研究的主要目的是调查围手术期低血压及其亚型（伴有或不伴有心输出量降低的低血压）的发生频率和分布情况。还探讨了有无心肌或急性肾损伤患者中低血压及其亚型的暴露情况。
结果
60例患者纳入分析。83%（50/60）的患者经历了围手术期低血压。每位患者低血压的中位持续时间为8.0[四分位间距，3.1 - 23.3]分钟。在77%的低血压持续时间内心输出量降低。术后发生心肌或急性肾损伤的患者在所有低血压亚型中的持续时间更长且暴露范围更广。然而，有无术后心肌或急性肾损伤的患者中不同低血压亚型的比例并无差异。
结论
在中高风险非心脏手术患者中，围手术期低血压常伴有心输出量降低。然而，由于本研究的试点性质，低血压亚型与术后心肌或急性肾损伤之间的关系仍需进一步探索。
临床试验注册
https://www.chictr.org.cn/showprojEN.html?proj=134260，CTR2200055929
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