【罂粟摘要】接受非心胸手术老年患者的目标平均动脉压管理：一项前瞻性随机对照试验
接受非心胸手术老年患者的目标平均动脉压管理：一项前瞻性随机对照试验
贵州医科大学 高鸿教授课题组
翻译：吴学艳 编辑：佟睿 审校：曹莹
本研究旨在评价低平均动脉压(MAP)与高平均动脉压(MAP)水平对老年患者接受非心脏手术术后谵妄发生率的影响。
多中心、随机、平行对照、开放标签、评估者盲法临床试验。
大学附属医院。
纳入322名接受全麻下行非心脏手术的患者，年龄≥65岁，ASA分级I-II级。
在全麻期间，参与者随机分为低水平MAP(60-70 mmHg)组和高水平MAP(90-100 mmHg)组；此项研究于2016年11月至2020年2月进行；纳入研究的均是接受非心胸手术的老年患者；术后随访1~7天，主要结果是观察患者术后谵妄的发生率。
共纳入322名随机分组的患者，298名完成住院期间的术后谵妄评估[中位数(四分位数范围)，73岁(68-77岁)；173名女性(58.1%)]；共有54例(18.1%)患者出现术后谵妄，其中低MAP组36例(24.5%)，高MAP组18例(11.9%)[相对危险度(RR)0.48，95%置信区间(CI)0.25~0.87，P=0.02]；多元回归分析调整后RR为0.34(95%CI为0.16~0.70，P<0.01)。与低水平MAP组相比，高水平MAP组患者术后谵妄发生率明显降低，持续时长短，术中尿量多。
在非心胸手术的老年患者中，高水平的血压管理可能有助于降低术后谵妄的发生率。
Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial
Abstract
Study objective: This study aimed to evaluate the effects of low versus high mean arterial pressure (MAP) levels on the incidence of postoperative delirium during non-cardiothoracic surgery in older patients.
Design:Multicenter, randomized, parallel-controlled, open-label, and assessor-blinded clinical trial.
Setting: University hospital.
Patients: Three hundred twenty-two patients aged ≥65 with an American Society of Anesthesiologists physical status of I-II who underwent non-cardiothoracic surgery with general anaesthesia.
Interventions: Participants were randomly assigned into a low-level MAP (60-70 mmHg) or high-level MAP (90-100 mmHg) group during general anaesthesia. The study was conducted from November 2016 to February 2020. Participants were older patients having non-cardiothoracic surgery. The follow-up period ranged from 1 to 7 days after surgery. The primary outcome was the incidence of postoperative delirium.
Main results: In total, 322 patients were included and randomized; 298 completed in-hospital delirium assessments [median (interquartile range) age, 73 (68-77) years; 173 (58.1%) women]. Fifty-four (18.1%) patients total, including 36 (24.5%) and 18 (11.9%) in the low-level and high-level MAP groups [relative risk (RR) 0.48, 95% confidence interval (CI) 0.25 to 0.87, P = 0.02], respectively, experienced postoperative delirium. The adjusted RR was 0.34 (95% CI 0.16 to 0.70, P < 0.01) in the multiple regression analysis. High-level MAP was associated with a shorter delirium span and a higher intraoperative urine volume than low-level MAP.
Conclusions: In older patients during non-cardiothoracic surgery, high-level blood pressure management might help reduce the incidence of postoperative delirium.
原始文献来源：
Hu AM, Qiu Y, Zhang P, et al.Higher versus lower mean arterial pressure target management in older patients having non-cardiothoracic surgery: A prospective randomized controlled trial.J Clin Anesth 2021 Jan 06;69.
.
翻译：吴学艳
编辑：佟睿
审校：曹莹