【罂粟摘要】非心脏手术的老年患者术中低血压及相关危险因素与术后死亡率的一项回顾性分析研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：安丽 编辑：潘志军 审校：曹莹
血压波动在老年人非心脏手术中非常常见。这项回顾性研究旨在分析老年人术中低血压和其他危险因素是否与术后死亡率相关。
选择2014年9月至2017年3月在3家医疗中心行非心脏手术的老年患者，其中236例生存病例(对照组)与118例死亡病例(观察组)进行对比分析，倾向匹配比例为1:2。两组患者的术中血压及围手术期参数均从电子麻醉记录单中采集。对P值小于0.05的变量进行多因素logistic回归分析，构建所选病例的工作特征(ROC)曲线。
非心脏手术的老年患者术后死亡的相关危险因素有5个因素:分别为ASA等级、慢性阻塞性肺疾病（COPD）、急诊手术,全身麻醉,60<MAP≤ 65mmHg。另外在PACU诊治是降低老年患者术后死亡率的一个因素。与对照组相比，观察组脑疝、肾损伤和外伤的比例较高（P<0.001）。观察组术中输血量和术中失血量均高于对照组（P<0.001）。观察组使用血管活性药物的比例较高（P<0.001），观察组术中尿量较多（P=0.005）。
老年患者术中MAP低于65mmHg与术后死亡率相关。有急诊手术、ASA高分级和COPD病史的老年患者术后死亡风险增加。全身麻醉是老年患者术后死亡的危险因素，PACU治疗是避免术后死亡的保护因素。
Benhui Zhao, Xingtong Chen, Qian Chen, Gaoming Li, Zhe Chen, Ziheng Yang, Li Gu,Xudong Xiao, Zhen Wang,6Jiaolin Ning, Bin Yi, Kaizhi Lu,Hongyan Zhang,7Jianteng Gu.Intraoperative Hypotension and Related Risk Factors for Postoperative Mortality After Noncardiac Surgery in Elderly Patients: A Retrospective Analysis Report.Clinical Interventions in Aging 2021:16, 1757–1767.
英文原文👇
Intraoperative Hypotension and Related Risk Factors for Postoperative Mortality After Noncardiac Surgery in Elderly Patients: A Retrospective Analysis Report.
Abstract
Background:Blood pressure fluctuation is very common during non-cardiac surgery in elderly. This retrospective study was to analyse whether intraoperative hypotension in elderly and other risk factors relate to the postoperative mortality.
Methods:A total of 118 cases (Observational group), who underwent noncardiac surgery in three medical centers between September 2014 and March 2017, and died in the hospital after the noncardiac surgery. With 1:2 ratio of propensity matching, 236 survival cases (Control group) were selected for comparison analyses with the death cases. Intraoperative blood pressure and perioperative parameters from both groups were collected from electronic anaesthesia charts. Data were analysed with univariate logistic regression analysis where variables with values less than 0.05 were analysed with multivariate logistic regression analysis. The receiver operating characteristic (ROC) curve was constructed.
Results:There are five risk factors related to postoperative death in elderly patients: ASA grade, COPD, emergency surgery, general anesthesia, 60<MAP≤ 65mmHg (OR>1), and one factor may reduce the risk of postoperative mortality, which is PACU therapy (OR <1). Compared with the Control group, the Observational group had a higher proportion of cerebral hernia, kidney injury and trauma (<0.001). The intraoperative blood transfusion volume and intraoperative blood loss volume were higher in the Observational group than the Control group (<0.001). The proportion of using vasoactive drugs was higher in the Observational group (<0.001), and there was more urine output during the operation in the Observational group ( =0.005).
Conclusion:The intraoperative MAP of geriatric patients lower than 65mmHg is highly related to the postoperative mortality. Elderly patients with emergency surgery, high ASA grade and a history of COPD have an increased risk of postoperative mortality. General anesthesia is a risk factor for postoperative death in elderly patients, and the PACU therapy is a protective factor to avoid postoperative death.