用于最小化术中低血压的低血压预测指数：随机对照试验的系统评价和荟萃分析

Hypotension prediction index for minimising intraoperative hypotension: A systematic review and meta-analysis of randomised controlled trials.

作者信息

Sriganesh Kamath, Francis Thomas, Mishra Rajeeb Kumar, Prasad Nisarga N, Chakrabarti Dhritiman

机构信息

Departments of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

Library and Information Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

出版信息

Indian J Anaesth. 2024 Nov;68(11):942-950. doi: 10.4103/ija.ija_677_24. Epub 2024 Oct 26.

BACKGROUND AND AIMS

Reports on the utility of the hypotension prediction index (HPI) in reducing the occurrence of intraoperative hypotension are conflicting. Therefore, the aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) was to evaluate the overall effect of using HPI on intraoperative hypotension outcomes of time-weighted average (TWA), area under the hypotension threshold (AUHT), incidence and duration of hypotension.

METHODS

We searched the electronic databases of PubMed, ProQuest and Scopus from inception till 30 October 2023. The search strategy was refined for each database. No time or language restrictions were applied. Only RCTs were included. The systematic review protocol is registered with PROSPERO (ID: CRD42023478150). Statistical analysis was performed using Review Manager Software.

RESULTS

Of 281 records, eight eligible RCTs (613 patients) were included. Significant differences were found between HPI and no HPI groups for the TWA of hypotension during surgery [mean difference (MD) = -0.19 mmHg, 95% confidence interval (95% CI): -0.31, -0.08, = 0.001], AUHT [MD = -65.03 (mmHg × min), 95% CI: -105.47, -24.59, = 0.002], incidence of hypotension (risk ratio = 0.83, 95% CI: 0.7, 0.99, = 0.04), total hypotension duration (MD = -12.07 min, 95% CI: -17.49, -6.66, < 0.001) and hypotension duration as a percentage of surgery time (MD = -6.30%, 95% CI: -10.23, -2.38, = 0.002).

CONCLUSIONS

Available evidence supports the role of HPI in minimising hypotension outcomes during surgery. The certainty of evidence is low to moderate for studied outcomes.

背景与目的

关于低血压预测指数（HPI）在降低术中低血压发生率方面的效用报告相互矛盾。因此，本随机对照试验（RCT）的系统评价和荟萃分析旨在评估使用HPI对术中低血压时间加权平均值（TWA）、低血压阈值下面积（AUHT）、低血压发生率和持续时间等结局的总体影响。

方法

我们检索了从数据库建立至2023年10月30日的PubMed、ProQuest和Scopus电子数据库。针对每个数据库对检索策略进行了优化。未设置时间或语言限制。仅纳入随机对照试验。该系统评价方案已在国际前瞻性系统评价注册库（PROSPERO）注册（注册号：CRD42023478150）。使用Review Manager软件进行统计分析。

结果

在281条记录中，纳入了8项符合条件的随机对照试验（613例患者）。发现HPI组与非HPI组在手术期间低血压的TWA[平均差（MD）=-0.19 mmHg，95%置信区间（95%CI）：-0.31，-0.08，P = 0.001]、AUHT[MD=-65.03（mmHg×min），95%CI：-105.47，-24.59，P = 0.002]、低血压发生率（风险比=0.83，95%CI：0.7，0.99，P = 0.04）、总低血压持续时间（MD=-12.07 min，95%CI：-17.49，-6.66，P < 0.001）以及低血压持续时间占手术时间的百分比（MD=-6.30%，95%CI：-10.23，-2.38，P = 0.002）方面存在显著差异。