【罂粟摘要】切皮前低血压小儿患者的麻醉特点:一项回顾性观察研究
切皮前低血压小儿患者的麻醉特点:一项回顾性观察研究
翻译：马艳燕 编辑：佟睿 审核：曹莹
贵州医科大学 高鸿教授课题组
术中血压已被认为是小儿麻醉安全的关键因素。然而，对于区分切皮前正常血压和低血压儿童的因素还没有太多的研究。我们的目的是探索麻醉期间血压偏低的儿童与血压正常的儿童是否不同。本研究的重点是切皮前阶段。
这项回顾性研究纳入2012至2016年间，一家三级大学附属儿科医院在麻醉后进行非心脏手术的儿科患者。我们分析了切皮前血压与病人特征和麻醉之间的关系，并将切皮前低血压与正常血压进行了比较。通过多变量线性回归进一步探讨了这种联系。
本研究共纳入20962例麻醉病例。切皮前血压与年龄(β-0.04SD/年)、性别(女性-0.11)、手术史(-0.15)、术前血压(+0.01/mmHg)、癫痫(0.12)、气道高反应(-0.18)、急诊手术(0.10)、局部操作(-0.48)、人工气道装置(声门上气道装置代替气管插管0.07)和七氟烷浓度(0.03/七氟烷%)有关。
切皮前血压低的儿童与血压正常的儿童在临床相关因素上没有不同。虽然目前的探索性研究表明，切皮前血压部分取决于患者的基本情况，部分取决于麻醉技术，但其他不可测量的变量可能起更重要的作用。
Pasma W, Peelen LM, van den Broek S, et al. Patient and anesthesia characteristics of children with low pre-incision blood pressure: A retrospective observational study. Acta Anaesthesiol Scand. 2020 Apr;64(4):472-480.
Patient and anesthesia characteristics of children with low pre-incision blood pressure, a retrospective observational study
Abstract
Background: Intraoperative blood pressure has been suggested as a key factor for safe pediatric anesthesia. However, there is not much insight into factors that discriminate between children with low and normal pre-incision blood pressure. Our aim was to explore if children who have a low blood pressure during anesthesia are different than those with normal blood pressure. The focus of the present study was on the pre-incision period.
Methods: This retrospective study included pediatric patients undergoing anesthesia for noncardiac surgery at a tertiary pediatric university hospital, between 2012 and 2016. We analyzed the association between pre-incision blood pressure and patient- and anesthesia characteristics, comparing low with normal pre-incision blood pressure. This association was further explored with a multivariable linear regression.
Results: In total, 20 962 anesthetic cases were included. Pre-incision blood pressure was associated with age (beta -0.04 SD per year), gender (female -0.11), previous surgery (-0.15), preoperative blood pressure (+0.01 per mmHg), epilepsy (0.12), bronchial hyperactivity (- 0.18), emergency surgery (0.10), locoregional technique (-0.48), artificial airway device (supgraglottic airway device instead of tube 0.07 and sevoflurane concentration (0.03 per sevoflurane %).
Conclusion: Children with low pre-incision blood pressure do not differ on clinically relevant factors from children with normal blood pressure. Although the present explorative study shows that pre-incision blood pressure is partly dependent on patient characteristics and partly dependent on anesthetic technique, other unmeasured variables might play a more important role.
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