Department of Emergency, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
Department of Neurosurgery, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, Guangdong, China.
Br J Hosp Med (Lond). 2024 Oct 30;85(10):1-13. doi: 10.12968/hmed.2024.0344. Epub 2024 Oct 27.
Previous studies have indicated a strong correlation between disturbances in blood pressure (BP) circadian rhythm and major cardiovascular adverse events. Similarly, blood pressure variability (BPV) has been closely linked to cerebral small vessel disease and leukoaraiosis. This study aims to investigate the relationship between BP rhythm and BPV with the short-term prognosis of patients with Type A aortic dissection, offering insights for targeted perioperative nursing interventions and improving patient outcomes. This retrospective study included patients undergoing surgical treatment for Type A aortic dissection at Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) from June 2022 to March 2024. The study followed patients from the completion of surgery to 30 days postoperatively, with all-cause mortality within 30 days as the endpoint representing poor short-term prognosis. Clinical data were compared along with: types of BP rhythm; BPV parameters including the mean 24-hour systolic BP (24hSBP), 24-hour diastolic BP (24hDBP), and pulse pressure; and the coefficient of variability (CV) for 24hSBP, 24hDBP, and pulse pressure. Multivariate logistic regression analysis was utilized to identify risk factors for poor short-term outcomes in these patients, and receiver operating characteristic (ROC) curves were plotted to assess the predictive value of BP rhythm types and BPV indicators. The study ultimately included 115 participants, with 31 deaths occurring within 30 days post-surgery, resulting in a postoperative mortality rate of 26.96%. The multivariate logistic regression analysis revealed that white blood cell count, neutrophil count, non-dipping BP rhythm, pulse pressure, and the CV for 24hSBP, 24hDBP, and pulse pressure, were significant risk factors for poor short-term prognosis ( < 0.05). The ROC curve analysis demonstrated that non-dipping BP rhythm, pulse pressure, 24hSBP-CV, 24hDBP-CV, and pulse pressure-CV had areas under the curve (AUC) of 0.685, 0.749, 0.751, 0.773, and 0.763, respectively. The combination of these indicators yielded the highest AUC at 0.918. A combination of BP rhythm and BPV indicators provides significant predictive value for poor short-term outcomes in patients with Type A aortic dissection. Clinicians and nursing staff can use these features to formulate targeted preventive measures.
先前的研究表明，血压（BP）昼夜节律紊乱与主要心血管不良事件之间存在很强的相关性。同样，血压变异性（BPV）与脑小血管疾病和脑白质疏松症密切相关。本研究旨在探讨 BP 节律和 BPV 与 A 型主动脉夹层患者短期预后的关系，为针对性围手术期护理干预提供依据，并改善患者预后。
本回顾性研究纳入了 2022 年 6 月至 2024 年 3 月在广东省人民医院（广东省医学科学院）接受 A 型主动脉夹层手术治疗的患者。研究从手术完成到术后 30 天随访患者，以 30 天内全因死亡率作为代表不良短期预后的终点。比较了临床数据以及：BP 节律类型；BPV 参数包括 24 小时收缩压（24hSBP）、24 小时舒张压（24hDBP）和脉压；以及 24hSBP、24hDBP 和脉压的变异系数（CV）。采用多变量 logistic 回归分析确定这些患者短期预后不良的危险因素，并绘制了受试者工作特征（ROC）曲线以评估 BP 节律类型和 BPV 指标的预测价值。
该研究最终纳入了 115 名患者，术后 30 天内有 31 人死亡，术后死亡率为 26.96%。多变量 logistic 回归分析显示，白细胞计数、中性粒细胞计数、非杓型血压节律、脉压以及 24hSBP、24hDBP 和脉压的 CV 是非短期预后不良的显著危险因素（<0.05）。ROC 曲线分析显示，非杓型血压节律、脉压、24hSBP-CV、24hDBP-CV 和脉压-CV 的曲线下面积（AUC）分别为 0.685、0.749、0.751、0.773 和 0.763，这些指标的组合具有最高的 AUC（0.918）。
BP 节律和 BPV 指标的组合对 A 型主动脉夹层患者短期预后不良具有显著的预测价值。临床医生和护理人员可以利用这些特征制定有针对性的预防措施。
