结直肠手术后低血压和手术部位感染的关系：回顾性队列研究
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Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery: A Retrospective Cohort Study
背景与目的
低血压可损害局部组织灌注，从而减少组织氧合，因此低血压可能会促进组织感染。在外科病房发生的低血压虽然通常不如术中低血压严重，但常见且病程较长。在这项回顾性队列研究中，我们假设手术部位的感染与术后时间加权平均动脉压和/或术后最小平均动脉压的降低之间存在关联。
方 法
我们纳入了2009年至2013年间在克利夫兰诊所进行结直肠手术持续≥1小时的患者。我们将血压的指标定义为手术后72小时内的时间加权平均值（初级）和最小平均动脉压（次级）。我们使用单独的严重程度加权平均相对效应广义估计方程模型来评估连续血压值与深部、浅表手术部位复合感染之间的关联，每个模型使用非结构化相关结构并调整潜在的混杂变量。
结 果
共有5896名患者符合分析条件。时间加权平均动脉压和手术部位感染无明显相关性，5 mmHg下降的优势比（95％CI）为1.03（0.99-1.08）（P = .16）。然而，术后最小平均动脉压与感染之间存在明显的负相关性，优势比为每5 mmHg下降1.08（1.03-1.12）（P = .001）。
结 论
术后时间加权平均动脉压与手术部位感染无关，但与术后最低平均动脉压有关。这种关系是否存在因果关系仍有待证明。
原始文献摘要
Yilmaz, Huseyin O, Babazade, et al. Postoperative Hypotension and Surgical Site Infections After Colorectal Surgery:, A Retrospective Cohort Study[J]. Anesthesia & Analgesia, 2018:1.
BACKGROUND: Hypotension compromises local tissue perfusion, thereby reducing tissue oxygenation. Hypotension might thus be expected to promote infection. Hypotension on surgical wards, while usually less severe than intraoperative hypotension, is common and often prolonged. In this retrospective cohort study, we tested the hypotheses that there is an association between surgical site infections and low postoperative time-weighted average mean arterial pressure and/or postoperative minimum mean arterial pressure.
METHODS: We considered patients who had colorectal surgery lasting ≥1 hour at the Cleveland Clinic between 2009 and 2013. We defined blood pressure exposures as time-weighted average (primary) and minimum mean arterial pressure (secondary) within 72 hours after surgery. We assessed associations between continuous blood pressure exposures with a composite of deep and superficial surgical site infection using separate severity-weighted average relative effect generalized estimating equations models, each using an unstructured correlation structure and adjusting for potentially confounding variables.
RESULTS: A total of 5896 patients were eligible for analysis. Time-weighted mean arterial pressure and surgical site infection were not significantly associated, with an estimated odds ratio (95% CI) of 1.03 (0.99–1.08) for a 5-mm Hg decrease (P = .16). However, there was a significant inverse association between minimum postoperative mean arterial pressure and infection, with an estimated odds ratio of 1.08 (1.03–1.12) per 5-mm Hg decrease (P = .001).
CONCLUSIONS: Postoperative time-weighted mean arterial pressure was not associated with surgical site infection, but lowest postoperative mean arterial pressure was. Whether the relationship is causal remains to be determined.
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