Park Yei Heum, Park Jae Hong, Choi Daeyun, Lee Min Woo, Oh Daeseok, Moon Sung Ho, Kwon Ji Yeon, Ko Myungjin
Department of Anesthesiology and Pain Medicine, Inje University Haeundae Paik Hospital, Busan, Korea.
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Anesth Pain Med. 2025 May 21;15(3):e161684. doi: 10.5812/aapm-161684. eCollection 2025 Jun 30.
Antihypertensive medications taken before surgery are associated with increased intraoperative hypotension, and patient positioning can further influence hemodynamics during surgery. However, the combined effects of antihypertensive medication use and patient positioning on intraoperative hypotension during spine surgery have not been clearly established.
This study aimed to investigate the incidence of hypotension in patients undergoing spine surgery according to surgical position, antihypertensive drug use, and patient characteristics through a retrospective analysis of medical records.
This retrospective study analyzed 4,973 patients who had undergone spine surgery. Demographic data, medical history, antihypertensive medication use before surgery, and anesthetic information, including blood pressure during surgery, were collected from electronic medical records (EMRs). The incidence of hypotension according to surgical positioning (supine vs. prone) and antihypertensive medication use was investigated.
The incidence of intraoperative hypotension was higher in patients positioned prone (supine: 19.06% vs. prone: 24.91%) and among those taking more antihypertensive medications (no medication: 19.49%; one medication: 25.18%; two or more medications: 32.97%). Logistic regression indicated that patients with a history of hypertension undergoing surgery in the prone position had a significantly greater risk of hypotension [odds ratio (OR) = 1.407] and severe hypotension (OR = 1.940) compared with those with no history of hypertension undergoing surgery in the supine position. Older age, longer anesthesia duration, cervical surgical site, and the use of multiple antihypertensive agents were associated with an increased risk of intraoperative hypotension. In particular, taking two or more antihypertensive drugs (OR = 1.601) and undergoing surgery in the prone position (OR = 1.505) were independent predictors of hypotension and severe hypotension during spine surgery.
Preoperative use of two or more antihypertensive medications increases the risk of intraoperative hypotension, and spine surgery in the prone position increases the risk of severe hypotension.
术前服用抗高血压药物与术中低血压发生率增加有关，并且患者体位可在手术期间进一步影响血流动力学。然而，脊柱手术期间抗高血压药物使用与患者体位对术中低血压的联合影响尚未明确确立。
本研究旨在通过对病历的回顾性分析，根据手术体位、抗高血压药物使用情况及患者特征，调查接受脊柱手术患者的低血压发生率。
这项回顾性研究分析了4973例接受脊柱手术的患者。从电子病历（EMR）中收集人口统计学数据、病史、术前抗高血压药物使用情况以及麻醉信息，包括术中血压。调查了根据手术体位（仰卧位与俯卧位）和抗高血压药物使用情况的低血压发生率。
俯卧位患者术中低血压发生率较高（仰卧位：19.06% 对比俯卧位：24.91%），且服用更多抗高血压药物的患者中发生率更高（未用药：19.49%；一种药物：25.18%；两种或更多药物：32.97%）。逻辑回归表明，与无高血压病史且接受仰卧位手术的患者相比，有高血压病史且接受俯卧位手术的患者发生低血压 [比值比（OR）= 1.407] 和严重低血压（OR = 1.940）的风险显著更高。年龄较大、麻醉持续时间较长、颈椎手术部位以及使用多种抗高血压药物与术中低血压风险增加相关。特别是，服用两种或更多抗高血压药物（OR = 1.601）和接受俯卧位手术（OR = 1.505）是脊柱手术期间低血压和严重低血压的独立预测因素。
术前使用两种或更多抗高血压药物会增加术中低血压风险，而俯卧位脊柱手术会增加严重低血压风险。
