Abstract：
Arterial pressure monitoring and management are mainstays of haemodynamic therapy in patients having surgery. This article presents updated consensus statements and recommendations on perioperative arterial pressure management developed during the 11th POQI PeriOperative Quality Initiative (POQI) consensus conference held in London, UK, on June 4-6, 2023, which included a diverse group of international experts. Based on a modified Delphi approach, we recommend keeping intraoperative mean arterial pressure ≥60 mm Hg in at-risk patients. We further recommend increasing mean arterial pressure targets when venous or compartment pressures are elevated and treating hypotension based on presumed underlying causes. When intraoperative hypertension is treated, we recommend doing so carefully to avoid hypotension. Clinicians should consider continuous intraoperative arterial pressure monitoring as it can help reduce the severity and duration of hypotension compared to intermittent arterial pressure monitoring. Postoperative hypotension is often unrecognised and might be more important than intraoperative hypotension because it is often prolonged and untreated. Future research should focus on identifying patient-specific and organ-specific hypotension harm thresholds and optimal treatment strategies for intraoperative hypotension including choice of vasopressors. Research is also needed to guide monitoring and management strategies for recognising, preventing, and treating postoperative hypotension.
摘要：
动脉压监测和管理是手术患者血液动力学治疗的主要手段。本文介绍了在伦敦举行的第11届POQI围手术期质量倡议（POQI）共识会议期间制定的关于围手术期动脉压管理的最新共识声明和建议。英国,2023年6月4日至6日，其中包括一组不同的国际专家。基于改进的德尔菲法，我们建议高危患者术中平均动脉压≥60mmHg.我们进一步建议在静脉或室压升高时增加平均动脉压目标，并根据推测的潜在原因治疗低血压。当治疗术中高血压时，我们建议这样做小心，以避免低血压。临床医生应考虑连续术中动脉压监测，因为与间歇性动脉压监测相比，它可以帮助减少低血压的严重程度和持续时间。术后低血压通常未被识别，并且可能比术中低血压更重要，因为它通常被延长且未经治疗。未来的研究应集中于确定患者特异性和器官特异性低血压的伤害阈值以及术中低血压的最佳治疗策略，包括血管加压药的选择。还需要进行研究，以指导监测和管理策略，以识别，预防,治疗术后低血压。
