Yang Peng, Fan Yu, Tang Wanyun
Department of Anesthesiology, Zigong First People's Hospital, 643000, Zigong, People's Republic of China.
Department of Orthopedics, Zigong First People's Hospital, No. 42, Yizhi Road, Shangyihao Street, Zigong, 643000, Sichuan, People's Republic of China.
Sci Rep. 2025 Apr 29;15(1):15007. doi: 10.1038/s41598-025-00019-0.
This study investigates the relationship between intraoperative blood pressure variability (BPV) and postoperative delirium (POD) after hip fracture surgery in geriatric patients. A retrospective analysis was conducted on 1002 geriatric patients who underwent hip fracture surgery. Intraoperative BPV was mainly quantified using the coefficient of variation in mean arterial pressure (CV-MAP). Patients were stratified into two groups (CV-MAP ≤ 10% vs. > 10%). Propensity score matching (PSM) balanced baseline characteristics. Multivariable logistic regression evaluated the association between CV-MAP and POD. Restricted cubic spline (RCS) analysis examined dose-response relationships. Subgroup analyses and interaction tests were conducted to examine effect modifications. POD occurred in 198 patients (19.8%). Patients with CV-MAP > 10% showed a significantly higher occurrence of POD than those with CV-MAP ≤ 10%, both before (24.6% vs. 16.4%, p < 0.001) and after PSM (25.2% vs. 18.9%, p = 0.032). Adjusted logistic regression confirmed CV-MAP > 10% as an independent predictor of POD (adjusted OR: 1.45, 95% CI 1.03-2.03, p = 0.033). RCS analysis revealed a nonlinear positive association between CV-MAP and POD risk. Subgroup analyses identified significant interactions between CV-MAP and variables such as age and ASA classification (p < 0.05). Elevated intraoperative BPV is independently associated with an increased risk of POD in elderly hip fracture patients, with nonlinear effects and potential modifiers. These findings underscore the importance of individualized blood pressure management to mitigate POD risk.
本研究调查老年患者髋部骨折手术后术中血压变异性（BPV）与术后谵妄（POD）之间的关系。对1002例行髋部骨折手术的老年患者进行回顾性分析。术中BPV主要采用平均动脉压变异系数（CV-MAP）进行量化。患者被分为两组（CV-MAP≤10%与>10%）。倾向评分匹配（PSM）平衡了基线特征。多变量逻辑回归评估CV-MAP与POD之间的关联。受限立方样条（RCS）分析检验剂量反应关系。进行亚组分析和交互检验以检验效应修饰。198例患者（19.8%）发生POD。CV-MAP>10%的患者POD发生率显著高于CV-MAP≤10%的患者，PSM前（24.6%对16.4%，p<0.001）和PSM后（25.2%对18.9%，p=0.032）均如此。调整后的逻辑回归证实CV-MAP>10%是POD的独立预测因素（调整后的OR：1.45，95%CI 1.03-2.03，p=0.033）。RCS分析显示CV-MAP与POD风险之间存在非线性正相关。亚组分析确定了CV-MAP与年龄和ASA分级等变量之间存在显著交互作用（p<0.05）。术中BPV升高与老年髋部骨折患者POD风险增加独立相关，具有非线性效应和潜在修饰因素。这些发现强调了个体化血压管理对降低POD风险的重要性。
