【罂粟摘要】非心脏手术后血压监测方式与并发症：一项前瞻性、多中心、观察队列研究
非心脏手术后血压监测方式与并发症：一项前瞻性、多中心、观察队列研究
控制血压仍然是围手术期保护的关键目标，因为低血压与手术后的不良后果相关。
我们探讨了通过监测动脉内血压提高警觉性是否能够降低术后发病率。
一项前瞻性的观察性队列研究。
四家英国二级护理医院。
共有4342名＞45岁且接受非心脏手术的患者。
我们比较了围术期接受动脉血压监测的患者和非侵入性测量血压的患者的结果。
在接受动脉血压和无创血压监测的患者之间，主要观察指标是围手术期心肌损伤(术后72h内高敏肌钙蛋白T≥15ng·L-1)。次要观察指标是手术后72小时内的发病率(术后发病率调查)，以及使用血管加压药和液体治疗。多变量Logistic回归分析探讨了发病率与年龄、性别、术后护理地点、血压/血流动力学监测方式和修订的心脏风险指数之间的关系。
动脉血压监测1137/4342例(26.2%)。动脉血压监测组发生心肌损害440/1137例(38.7%)，无创监测组824/3205例(25.7%)[OR1.82(95%CI 1.58~2.11)，P<0.001]。在调整潜在的混杂变量后，动脉血压监测仍然与心肌损伤相关[调整后的OR 1.56(1.29~1.89)，P<0.001]。预计进入ICU与病房进行术后护理的结果相似。
在控制了手术和患者因素后，动脉血压监测与非心脏手术后并发症风险更为相关。这些数据为最终监测试验的设计提供了有参考价值的方法。
Mode of blood pressure monitoring and morbidity after noncardiac surgery: A prospective multicentre observational cohort study
BACKGROUND Control of blood pressure remains a key goal of peri-operative care, because hypotension is associated with adverse outcomes after surgery.
OBJECTIVES We explored whether increased vigilance afforded by intra-arterial blood pressure monitoring may be associated with less morbidity after surgery.
DESIGNA prospective observational cohort study.
SETTING Four UK secondary care hospitals. PATIENTS A total of 4342 patients＞45 years who underwent noncardiac surgery.
METHODS We compared outcome of patients who received peri-operative intra-arterial blood pressure monitoring with those whose blood pressure was measured noninvasively.
OUTCOMES The primary outcome was peri-operative myocardial injury (high-sensitivity troponin-T≥15ng·L-1within 72 h after surgery), compared between patients who received intra-arterial versus noninvasive blood pressure monitoring. Secondary outcomes were morbidity within 72 h of surgery (postoperative morbidity survey),and vasopressor and fluid therapy. Multivariable logistic regression analysis explored associations between morbidity and age, sex, location of postoperative care, mode of blood pressure/haemodynamic monitoring and Revised Cardiac Risk Index.
RESULTS Intra-arterial monitoring was used in 1137/4342 (26.2%) patients. Myocardial injury occurred in 440/1137 (38.7%) patients with intra-arterial monitoring compared with 824/3205 (25.7%) with noninvasive monitoring [OR 1.82 (95% CI 1.58 to 2.11), P<0.001]. Intra-arterial monitoring remained associated with myocardial injury when adjusted for potentially confounding variables [adjusted OR 1.56 (1.29 to 1.89), P<0.001). The results were similar for planned ICU versus ward postoperative care.
CONCLUSIONS Intra-arterial monitoring is associated with greater risk of morbidity after noncardiac surgery, after controlling for surgical and patient factors. These data provide useful insights into the design of a definitive monitoring trial.
翻译：佟睿 编辑：佟睿 审校：曹莹
贵州医科大学 高鸿教授课题组