Rose D K, Cohen M M, DeBoer D P
Department of Anaesthesia, St. Michael's Hospital, Toronto, Canada.
Anesthesiology. 1996 Apr;84(4):772-81. doi: 10.1097/00000542-199604000-00003.
The purpose of this study was to determine the relationship of four postanesthesia care unit (PACU) cardiovascular events to long-term outcomes (unplanned critical care admission or mortality) and to evaluate the contribution of anesthetic management compared with other perioperative factors in predicting these events.
For patients admitted to the PACU after receiving general anesthesia (n = 18,380), the risk of long-term outcomes was examined for patients in the PACU with hypertension, tachycardia, bradycardia, or hypotension. Using logistic regression (P < 0.05), risk factors (grouped as patients, surgical, anesthetic, operating room observations, and other PACU observations) for each cardiovascular event were determined. For each factor grouping, the relative contributions to each cardiovascular event were compared using maximum likelihood chi-square analysis.
Patients in the PACU with hypertension or tachycardia had more unplanned critical care admissions (2.6% and 4.0% vs. 0.2% for patients with no events) and greater mortality (1.9% and 2.3% vs. 0.3% and 0.4%) (P < 0.01). For PACU hypertension (rate 2.0%), age, smoking, renal disease, female gender, and angina were significant risk factors. For PACU tachycardia (0.9%), intraoperative tachycardia and dysrhythmia were the major contributors. Patient factors also increased the risk of bradycardia (2.5%); namely age, ASA physical status 1 or 2, and preoperative beta blocker therapy. For hypotension (2.2%), duration of surgery > 2 h, completion after 6 PM, and gynecologic intraabdominal procedures were significant risk factors. Compared to patient, surgical, intraoperative, or PACU observations, anesthetic factors studied (premedication, induction agent, ventilation, use of opioids) provided only a small contribution in predicting these events.
Hypertension and tachycardia in the PACU, although infrequent, are associated with increased risk of unplanned critical care admission and mortality. Patient, surgical, intraoperative, or PACU observations contribute more to cardiovascular events in the PACU than do differences in anesthetic management identified in this study.
本研究旨在确定四个麻醉后监护病房（PACU）心血管事件与长期预后（非计划重症监护病房入院或死亡）之间的关系，并评估麻醉管理相较于其他围手术期因素在预测这些事件中的作用。
对于接受全身麻醉后入住PACU的患者（n = 18,380），研究了PACU中患有高血压、心动过速、心动过缓或低血压患者的长期预后风险。使用逻辑回归（P < 0.05）确定每个心血管事件的危险因素（分为患者、手术、麻醉、手术室观察和其他PACU观察）。对于每个因素分组，使用最大似然卡方分析比较对每个心血管事件的相对贡献。
PACU中患有高血压或心动过速的患者有更多非计划重症监护病房入院（分别为2.6%和4.0%，无事件患者为0.2%）以及更高的死亡率（分别为1.9%和2.3%，无事件患者为0.3%和0.4%）（P < 0.01）。对于PACU高血压（发生率2.0%），年龄、吸烟、肾脏疾病、女性性别和心绞痛是显著危险因素。对于PACU心动过速（0.9%），术中心动过速和心律失常是主要因素。患者因素也增加了心动过缓（2.5%）的风险；即年龄、美国麻醉医师协会身体状况1或2级以及术前β受体阻滞剂治疗。对于低血压（2.2%），手术时间> 2小时、下午6点后完成手术以及妇科腹腔内手术是显著危险因素。与患者、手术、术中或PACU观察相比，所研究的麻醉因素（术前用药、诱导剂、通气、阿片类药物使用）在预测这些事件中贡献较小。
PACU中的高血压和心动过速虽然不常见，但与非计划重症监护病房入院和死亡风险增加相关。患者、手术、术中或PACU观察对PACU中心血管事件的影响比本研究中确定的麻醉管理差异更大。
