腹腔镜胃肠手术中术中低血压与术后恶心呕吐的关联：一项随机试验的二次分析
Association of Intraoperative Hypotension with Postoperative Nausea and Vomiting in Laparoscopic Gastrointestinal Surgery: A Secondary Analysis of a Randomized Trial.
作者信息
Li Zijia, Zhao Yingyin, Shi Jiankun, Liang Chujun, Zhang Shimin, Zheng Jiayi, Bizo Mailoga Nassirou, Zhao Yang
机构信息
Department of Anesthesia, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China; Biomedical Innovation Center, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Anesthesia, Jiangmen Central Hospital, Jiangmen Hospital Affiliated to Sun Yat-sen University, Jiangmen, China.
出版信息
Anesthesiology. 2025 Sep 1;143(3):582-592. doi: 10.1097/ALN.0000000000005585. Epub 2025 Jun 2.
BACKGROUND
Few studies have examined the association between intraoperative hypotension and postoperative nausea and vomiting (PONV), and no definitive conclusions have been established. This study investigated the association between intraoperative hypotension and PONV in patients undergoing laparoscopic gastrointestinal surgery.
METHODS
This secondary analysis of a randomized trial included adult patients at high risk for PONV undergoing laparoscopic gastrointestinal surgery. Intraoperative hypotension was quantified as a time-weighted average mean arterial pressure (TWA-MAP) less than 65 mmHg. Primary and secondary outcomes were PONV within 0 to 24 h and 25 to 120 h after surgery, respectively. The authors assessed the association between intraoperative hypotension and outcomes using restricted cubic splines and multiple logistic regression models, adjusting for potential confounders. Sensitivity analyses were conducted using various mean arterial pressure thresholds (70, 60, 55 mmHg) and metrics (area under the curve [AUC], duration) with similar models.
RESULTS
In total, 1,093 patients were included (median age, 56 yr; 1,054 [96.4%] women). The medians [interquartile ranges] of TWA-MAP less than 65 mmHg, AUC, and duration of mean arterial pressure less than 65 mmHg were 0.03 [0.00, 0.14] mmHg, 6.33 [0.17, 30.17] mmHg · min, and 1.83 [0.17, 7.00] min, respectively. The overall incidence of PONV within 0 to 24 h and 25 to 120 h after surgery was 40.4% and 42.9%, respectively. No exposure-response relationship was found between TWA-MAP less than 65 mmHg and either the primary or secondary outcome. Compared with the first tertile of TWA-MAP less than 65 mmHg, patients in the second and third tertiles did not have a higher risk of primary outcome (adjusted odds ratio, 0.92 [95% CI, 0.67 to 1.24; P = 0.569] and 0.95 [95% CI, 0.70 to 1.30; P = 0.755], respectively) or secondary outcome (adjusted odds ratio, 1.05 [95% CI, 0.77 to 1.42; P = 0.772] and 0.86 [95% CI, 0.63 to 1.18; P = 0.360], respectively). Intraoperative hypotension was not associated with PONV in any sensitivity analyses.
CONCLUSIONS
Intraoperative hypotension was not associated with PONV in patients at high risk of PONV who underwent laparoscopic gastrointestinal surgery.
背景
很少有研究探讨术中低血压与术后恶心呕吐（PONV）之间的关联，尚未得出明确结论。本研究调查了接受腹腔镜胃肠手术患者术中低血压与PONV之间的关联。
方法
这项对一项随机试验的二次分析纳入了接受腹腔镜胃肠手术且有PONV高风险的成年患者。术中低血压定义为时间加权平均动脉压（TWA-MAP）低于65 mmHg。主要和次要结局分别为术后0至24小时和25至120小时内的PONV。作者使用受限立方样条和多元逻辑回归模型评估术中低血压与结局之间的关联，并对潜在混杂因素进行校正。使用各种平均动脉压阈值（70、60、55 mmHg）和指标（曲线下面积[AUC]、持续时间）以及类似模型进行敏感性分析。
结果
总共纳入了1093例患者（中位年龄56岁；1054例[96.4%]为女性）。TWA-MAP低于65 mmHg的中位数[四分位间距]、AUC以及平均动脉压低于65 mmHg的持续时间分别为0.03[0.00，0.14]mmHg、6.33[0.17，30.17]mmHg·min和1.83[0.17，7.00]min。术后0至24小时和25至120小时内PONV的总体发生率分别为40.4%和42.9%。未发现TWA-MAP低于65 mmHg与主要或次要结局之间存在暴露-反应关系。与TWA-MAP低于65 mmHg的第一个三分位数相比，第二个和第三个三分位数的患者主要结局风险未升高（校正比值比分别为0.92[95%CI，0.67至1.24；P = 0.569]和0.95[95%CI，0.70至1.30；P = 0.755]），次要结局风险也未升高（校正比值比分别为1.05[95%CI，0.77至1.42；P = 0.772]和0.86[95%CI，0.63至1.18；P = 0.360]）。在任何敏感性分析中，术中低血压均与PONV无关。
结论
在接受腹腔镜胃肠手术且有PONV高风险的患者中，术中低血压与PONV无关。
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