【罂粟摘要】临床实践中术中低血压的治疗阈值—一项英国老年患者的前瞻性队列研究
临床实践中术中低血压的治疗阈值—一项英国老年患者的前瞻性队列研究
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
术中低血压常使老年患者麻醉复杂化，并与围手术期器官灌注不足和损伤有关；在英国低血压的患病率和相应的治疗阈值尚不明确。本研究旨在确定英国手术中低血压的发生率及其治疗阈值。英国196家医院在48小时内对≥65岁患者进行了前瞻性研究，首要观察指标为低血压的发生率(平均动脉压<65 mmHg，收缩压降低>20%，收缩压< 100mmHg),次要观察指标包括需血管活性药物治疗的血压阈值、急性肾损伤发生率、心肌损伤、中风、住院期间死亡率。此外，要求为患者提供麻醉护理的麻醉医生完成一项调查，评估他们对低血压的预期治疗阈值，研究共纳入4750名患者数据。 当定义为平均动脉压<65 mmHg时，61.0%的患者发生低血压，91.3%的患者收缩压较基础血压下降20%，77.5%收缩压<100 mmHg。平均(SD)血压触发升压治疗的平均动脉压为64.2 (11.6)mmHg，调查显示的平均(SD)预期治疗阈值为平均动脉压60.6 (9.7)mmHg。345例患者(7.3%)出现心肌损伤、肾损伤、中风或死亡的不良预后。在英国围手术期实践的代表性样本中，大多数老年患者经历了术中低血压，治疗低于建议的阈值；研究结果强调了术中低血压可能造成器官损伤，也强调了改善术中低血压治疗的实质性机会。
Wickham AJ, Highton DT, Clark S, et al. Treatment threshold for intra-operative hypotension in clinical practice-a prospective cohort study in older patients in the UK[J]. Anaesthesia. 2021 Jul 6. DOI: 10.1111/anae.15535.
Treatment threshold for intra-operative hypotension in clinical practice—a prospective cohort study in older patients in the UK
Intra-operative hypotension frequently complicates anaesthesia in older patients and is implicated in peri-operative organ hypoperfusion and injury. The prevalence and corresponding treatment thresholds of hypotension are incompletely described in the UK. This study aimed to identify prevalence of intra-operative hypotension and its treatment thresholds in UK practice. Patients aged ≥ 65 years were studied prospectively from 196 UK hospitals within a 48-hour timeframe. The primary outcome was the incidence of hypotension (mean arterial pressure <65 mmHg; systolic blood pressure reduction >20%; systolic blood pressure <100 mmHg). Secondary outcomes included the treatment blood pressure threshold for vasopressors; incidence of acute kidney injury; myocardial injury; stroke; and in-hospital mortality. Additionally, anaesthetists providing care for included patients were asked to complete a survey assessing their intended treatment thresholds for hypotension. Data were collected from 4750 patients. Hypotension affected 61.0% of patients when defined as mean arterial pressure <65 mmHg, 91.3% of patients had >20% reduction in systolic blood pressure from baseline and 77.5% systolic blood pressure <100 mmHg. The mean (SD) blood pressure triggering vasopressor therapy was mean arterial pressure 64.2 (11.6) mmHg and the mean (SD) stated intended treatment threshold from the survey was mean arterial pressure 60.6 (9.7) mmHg. A composite adverse outcome of myocardial injury, kidney injury, stroke or death affected 345 patients (7.3%). In this representative sample of UK peri-operative practice, the majority of older patients experienced intra-operative hypotension and treatment was delivered below suggested thresholds. This highlights both potential for intra-operative organ injury and substantial opportunity for improving treatment of intra-operative hypotension.