全身麻醉下非心脏手术患者动态血压测量与术中低血压的关系：一项前瞻性观察研究
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Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia：A Prospective Observational Study
背景与目的
正常血压在个体间以及昼夜节律周期上存在差异。麻醉诱导前血压可能不能代表患者的正常血压曲线，也不能给出患者正常血压范围的指示。因此，本研究旨在确定动态平均动脉压与诱导前、诱导后和术中平均动脉压的关系。
方 法
前瞻性地测量和比较370名年龄在40至65岁之间ASA分级I或II级择期非心脏手术患者的动态平均动脉压(30分钟间隔的自动化振荡测量)、诱导前、诱导后和术中平均动脉压(1分钟间隔)。
结 果
第一次诱导前平均动脉压与日间平均动脉压之间仅有微弱的相关性(r=0.429，P<0.001)。第一次诱导前和平均日间平均动脉压的差异在个体间存在显著差异。在大约三分之二的患者中，诱导后和术中的最低平均动脉压低于最低夜间平均动脉压。夜间最低平均动脉压与65mmHg平均动脉压之间的差异在个体间存在很大差异。263例患者的(71%)夜间平均动脉压低于65mmHg。
结 论
诱导前平均动脉压不能作为白天平均动脉压正常值。大多数患者诱导后最低平均动脉压和术中平均动脉压低于夜间最低平均动脉压。
原始文献摘要
Bernd Saugel；Philip C. Reese；Automated Ambulatory Blood Pressure Measurements and Intraoperative Hypotension in Patients Having Noncardiac Surgery with General Anesthesia：A Prospective Observational Study；Anesthesiology 2019; 131:74–83
Background: Normal blood pressure varies among individuals and over the circadian cycle. Preinduction blood pressure may not be representative of a patient’s normal blood pressure profile and cannot give an indication of a patient’s usual range of blood pressures. This study therefore aimed to determine the relationship between ambulatory mean arterial pressure and preinduction, postinduction, and intraoperative mean arterial pressures.
Methods: Ambulatory (automated oscillometric measurements at 30-min intervals) and preinduction, postinduction, and intraoperative mean arterial pressures (1-min intervals) were prospectively measured and compared in 370 American Society of Anesthesiology physical status classification I or II patients aged 40 to 65 yr having elective noncardiac surgery with general anesthesia.
Results: There was only a weak correlation between the first preinduction and mean daytime mean arterial pressure (r = 0.429, P < 0.001). The difference between the first preinduction and mean daytime mean arterial pressure varied considerably among individuals. In about two thirds of the patients, the lowest postinduction and intraoperative mean arterial pressures were lower than the lowest nighttime mean arterial pressure. The difference between the lowest nighttime mean arterial pressure and a mean arterial pressure of 65 mmHg varied considerably among individuals. The lowest nighttime mean arterial pressure was higher than 65 mmHg in 263 patients (71%).
Conclusions: Preinduction mean arterial pressure cannot be used as a surrogate for the normal daytime mean arterial pressure. The lowest postinduction and intraoperative mean arterial pressures are lower than the lowest nighttime mean arterial pressure in most patients.
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翻译：余晓旭 编辑：何幼芹 审校：王贵龙