Duda Izabela, Hofman Mariusz, Dymek Mikołaj, Liberski Piotr, Wojtacha Maciej, Szczepańska Anna
Department of Anaesthesiology and Intensive Care, Faculty of Medical Sciences, Medical University of Silesia, 40-055 Katowice, Poland.
Department of Neurosurgery, University Clinical Center of the Medical University of Silesia, 40-055 Katowice, Poland.
J Clin Med. 2024 Oct 9;13(19):6021. doi: 10.3390/jcm13196021.
The subject of this study is intraoperative hypotension during the evacuation of acute subdural haematoma (ASH). We examined the association between the decrease in intraoperative blood pressure (BP) after the induction of anaesthesia and the decrease in BP after opening the dura mater. The second aim of this study was to assess the relationship between preoperative hypertension and the emergence of an intraoperative drop in BP. This was a retrospective cohort study on adult patients undergoing emergency craniotomy due to ASH. In total, 165 medical records from a 2-year period were analysed. The patients were divided into two groups: high blood pressure (HBP) (n = 89) and normal blood pressure (NBP) (n = 76). The HBP group included patients with hypertension in the preoperative period (systolic blood pressure (SBP) > 150 mmHg). The NBP group included patients with an SBP between 90 and 150 mmHg. We observed a significant drop in blood pressure in two operational periods: after the induction of anaesthesia and after opening the dura mater. A highly relevant positive correlation was noted between the decrease in SBP after anaesthesia induction and the opening of the dura mater ( < 0.001). In the HBP group, after opening the dura mater, there was a 44% SBP decrease from the baseline value. The reduction in BP after the induction of anaesthesia is a predictor of a subsequent drop in BP after opening the dura mater during urgent surgery due to ASH. Patients with hypertension in the preoperative period of ASH tend to have a greater intraoperative drop in BP and worse outcomes.
本研究的主题是急性硬膜下血肿（ASH）清除术中的术中低血压。我们研究了麻醉诱导后术中血压（BP）下降与硬脑膜打开后血压下降之间的关联。本研究的第二个目的是评估术前高血压与术中血压下降的出现之间的关系。这是一项针对因ASH接受急诊开颅手术的成年患者的回顾性队列研究。总共分析了2年期间的165份病历。患者分为两组：高血压（HBP）组（n = 89）和正常血压（NBP）组（n = 76）。HBP组包括术前患有高血压（收缩压（SBP）> 150 mmHg）的患者。NBP组包括SBP在90至150 mmHg之间的患者。我们观察到在两个手术阶段血压有显著下降：麻醉诱导后和硬脑膜打开后。麻醉诱导后SBP下降与硬脑膜打开之间存在高度相关的正相关（< 0.001）。在HBP组中，硬脑膜打开后，SBP较基线值下降了44%。麻醉诱导后血压下降是ASH急诊手术中硬脑膜打开后随后血压下降的一个预测指标。ASH术前患有高血压的患者术中血压下降往往更大，预后更差。
