Kelly Patrick D, Gauhar Fatima, Kang KiChang, Kayne Allison, Bray David P, Evans James J
Department of Neurosurgery, Vanderbilt University Medical Center, Nashville , Tennessee , USA.
Department of Neurosurgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York , New York , USA.
Neurosurgery. 2024 Nov 26;97(1):213-222. doi: 10.1227/neu.0000000000003293.
Acute hypertension can occur in 90% of postcraniotomy patients for tumor resection, and 60% to 90% of patients require treatment with antihypertensive agents. Postoperative intracranial hemorrhage is a major driver of morbidity and mortality after craniotomy for tumor resection, and perioperative hypertension is believed to be a risk factor. Many neurosurgeons impose postoperative blood pressure (BP) goals to mitigate this risk, but there is little evidence to guide the selection of a specific target BP, leading to a wide variation in patient care. In this article, we have conducted a national survey to report the current practices regarding postoperative BP management.
We conducted a cross-sectional survey of academic neurosurgical programs by distributing a 10-item questionnaire to neurosurgical residents of each accredited national neurosurgical residency training program (n = 117). Responses were collected over 3 months, from July 2023 to September 2023. Analysis was performed at the program level; for programs with multiple responding residents, the responses of the senior residents were retained.
Responses were received from 66 residents at 45 institutions. Forty-two programs set postoperative BP goals using systolic blood pressure (SBP) as a parameter, and 2 used mean arterial pressure. Among programs using an SBP goal, most programs kept a goal SBP of <140 mm Hg (41%-43% depending on the tumor type), followed by SBP <160 mm Hg (36%-39%). Most programs maintained this goal until the morning of the first postoperative day. Intravenous nicardipine (n = 12, 27%) and labetalol (n = 12, 27%) were the most frequently administered medications to maintain BP goals.
Most of the academic neurosurgical programs use a postoperative SBP goal after craniotomy for tumor resection. Programs are evenly divided between goals of SBP <140 mm Hg and SBP <160 mm Hg. The variability among programs indicates clinical equipoise between these 2 approaches in the context of a future clinical trial.
90%的接受开颅肿瘤切除术的患者会出现急性高血压，60%至90%的患者需要使用抗高血压药物治疗。术后颅内出血是开颅肿瘤切除术后发病和死亡的主要原因，围手术期高血压被认为是一个危险因素。许多神经外科医生设定术后血压（BP）目标以降低这种风险，但几乎没有证据指导选择特定的目标血压，导致患者护理存在很大差异。在本文中，我们进行了一项全国性调查，以报告术后血压管理的当前做法。
我们通过向每个经认可的全国神经外科住院医师培训项目（n = 117）的神经外科住院医师发放一份10项问卷，对学术性神经外科项目进行了横断面调查。从2023年7月至2023年9月的3个月内收集回复。在项目层面进行分析；对于有多名回复住院医师的项目，保留高级住院医师的回复。
收到了来自45个机构的66名住院医师的回复。42个项目使用收缩压（SBP）作为参数设定术后血压目标，2个项目使用平均动脉压。在使用SBP目标的项目中，大多数项目将目标SBP设定为<140 mmHg（根据肿瘤类型为41% - 43%），其次是SBP <160 mmHg（36% - 39%）。大多数项目在术后第一天早晨之前维持该目标。静脉注射尼卡地平（n = 12，27%）和拉贝洛尔（n = 12，27%）是最常用于维持血压目标的药物。
大多数学术性神经外科项目在开颅肿瘤切除术后使用术后SBP目标。项目在SBP <140 mmHg和SBP <160 mmHg目标之间平均分配。项目之间的差异表明在未来临床试验背景下这两种方法在临床 equipoise 方面。 （注：“equipoise”这个词在医学语境中可能是特定术语，这里直接保留英文，具体含义需结合专业知识进一步理解）
