持续无创血压监测在非心脏手术中的作用：随机临床试验
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A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery
背景与目的：术中低血压与术后死亡率相关。通过持续血流动力学监测可促进早期发现低血压并及时治疗，从而减少术中低血压的发生。本试验假设持续无创血压监测可减少术中低血压的发生率。
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方法：本试验纳入了年龄 ≥45岁、ASA分级III或IV级、中度至高风险非心脏手术全身麻醉患者。所有参与研究的患者均使用指套（ClearSight，Edwards Lifesciences，Irvine，CA）和标准示波袖带进行持续无创血流动力学监测。在随机分配的一半患者中，临床医生对连续值不知情，而研究者（非盲人）可以获得连续的血压读数。分析比较两组患者的连续血压值及平均动脉压的加权平均值。
结果：在320名随机患者中，316名患者纳入该研究，平均每组158名患者。与间断血压监测患者组比较，接受连续血压监测的患者的时间加权平均动脉压显着降低（<65 mm Hg）。
结论：持续无创血流动力学监测可减少术中低血压的发生率。目前，通过连续监测降低血压虽然具有统计学意义，但其临床意义尚不确定。
Maheshwari K, Khanna S, Bajracharya G R, et al. A Randomized Trial of Continuous Noninvasive Blood Pressure Monitoring During Noncardiac Surgery.[J]. Anesthesia & Analgesia, 2018.
BACKGROUND:Intraoperative hypotension is associated with postoperative mortality. Early detection of hypotension by continuous hemodynamic monitoring might prompt timely therapy, thereby reducing intraoperative hypotension. We tested the hypothesis that continuous noninvasive blood pressure monitoring reduces intraoperative hypotension.
METHODS:Patients ≥45 years old with American Society of Anesthesiologists physical status III or IV having moderate-to-high-risk noncardiac surgery with general anesthesia were included. All participating patients had continuous noninvasive hemodynamic monitoring using a finger cuff (ClearSight, Edwards Lifesciences, Irvine, CA) and a standard oscillometric cuff. In half the patients, randomly assigned, clinicians were blinded to the continuous values, whereas the others (unblinded) had access to continuous blood pressure readings. Continuous pressures in both groups were used for analysis. Time-weighted average for mean arterial pressure <65 mm Hg was compared using 2-sample Wilcoxon rank-sum tests and Hodges Lehmann estimation of location shift with corresponding asymptotic 95% CI.
RESULTS:Among 320 randomized patients, 316 were included in the intention-to-treat analysis. With 158 patients in each group, those assigned to continuous blood pressure monitoring had significantly lower time-weighted average mean arterial pressure <65 mm Hg, 0.05 [0.00, 0.22] mm Hg, versus intermittent blood pressure monitoring, 0.11 [0.00, 0.54] mm Hg (P = .039, significance criteria P < .048).
CONCLUSIONS:Continuous noninvasive hemodynamic monitoring nearly halved the amount of intraoperative hypotension. Hypotension reduction with continuous monitoring, while statistically significant, is currently of uncertain clinical importance.
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