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Abstract：
BACKGROUND: Intraoperative persistent hypotension (IPH) during pancreaticoduodenectomy (PD) is linked to adverse postoperative outcomes, yet its risk factors remain unclear.
OBJECTIVE: To clarify the risk factors associated with IPH during PD, ensuring patient safety in the perioperative period.
METHODS: A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD. These factors included age, gender, body mass index, American Society of Anesthesiologists classification, comorbidities, medication history, operation duration, fluid balance, blood loss, urine output, and blood gas parameters. IPH was defined as sustained mean arterial pressure < 65 mmHg, requiring prolonged deoxyepinephrine infusion for > 30 min despite additional deoxyepinephrine and fluid treatments.
RESULTS: Among 1596 PD patients, 661 (41.42%) experienced IPH. Multivariate logistic regression identified key risk factors: increased age [odds ratio (OR): 1.20 per decade, 95% confidence interval (CI): 1.08-1.33] (P < 0.001), longer surgery duration (OR: 1.15 per additional hour, 95%CI: 1.05-1.26) (P < 0.01), and greater blood loss (OR: 1.18 per 250-mL increment, 95%CI: 1.06-1.32) (P < 0.01). A novel finding was the association of arterial blood Ca2+ < 1.05 mmol/L with IPH (OR: 2.03, 95%CI: 1.65-2.50) (P < 0.001).
CONCLUSIONS: IPH during PD is independently associated with older age, prolonged surgery, increased blood loss, and lower plasma Ca2+.
OBJECTIVE: To clarify the risk factors associated with IPH during PD, ensuring patient safety in the perioperative period.
METHODS: A retrospective analysis of patient records from January 2018 to December 2022 at the First Affiliated Hospital of Nanjing Medical University identified factors associated with IPH in PD. These factors included age, gender, body mass index, American Society of Anesthesiologists classification, comorbidities, medication history, operation duration, fluid balance, blood loss, urine output, and blood gas parameters. IPH was defined as sustained mean arterial pressure < 65 mmHg, requiring prolonged deoxyepinephrine infusion for > 30 min despite additional deoxyepinephrine and fluid treatments.
RESULTS: Among 1596 PD patients, 661 (41.42%) experienced IPH. Multivariate logistic regression identified key risk factors: increased age [odds ratio (OR): 1.20 per decade, 95% confidence interval (CI): 1.08-1.33] (P < 0.001), longer surgery duration (OR: 1.15 per additional hour, 95%CI: 1.05-1.26) (P < 0.01), and greater blood loss (OR: 1.18 per 250-mL increment, 95%CI: 1.06-1.32) (P < 0.01). A novel finding was the association of arterial blood Ca2+ < 1.05 mmol/L with IPH (OR: 2.03, 95%CI: 1.65-2.50) (P < 0.001).
CONCLUSIONS: IPH during PD is independently associated with older age, prolonged surgery, increased blood loss, and lower plasma Ca2+.
摘要：
背景：胰十二指肠切除术（PD）期间的术中持续性低血压（IPH）与术后不良结局有关，但其风险因素仍不清楚。
目的：为了阐明PD期间与IPH相关的危险因素，确保围手术期患者的安全。
方法：回顾性分析南京医科大学第一附属医院2018年1月至2022年12月的患者记录，确定了与PD中IPH相关的因素。这些因素包括年龄，性别,身体质量指数,美国麻醉医师学会分类，合并症,用药史,操作持续时间,流体平衡,失血,尿量,和血气参数。IPH定义为持续平均动脉压<65mmHg，尽管需要额外的脱氧肾上腺素和液体治疗，但需要长时间输注脱氧肾上腺素>30分钟。
结果：在1596例PD患者中，661人（41.42%）经历了IPH。多变量逻辑回归确定了关键风险因素：年龄增加[比值比（OR）：每十年1.20，95%置信区间（CI）：1.08-1.33]（P<0.001），手术持续时间更长(OR：每小时1.15，95CI：1.05-1.26）（P<0.01），和更大的失血量(OR：每250毫升增加1.18，95CI：1.06-1.32）（P<0.01）。一个新的发现是动脉血Ca2+<1.05mmol/L与IPH（OR：2.03，95CI：1.65-2.50）（P<0.001）。
结论：PD期间的IPH与年龄无关，长时间的手术,失血量增加,和较低的血浆Ca2+。
目的：为了阐明PD期间与IPH相关的危险因素，确保围手术期患者的安全。
方法：回顾性分析南京医科大学第一附属医院2018年1月至2022年12月的患者记录，确定了与PD中IPH相关的因素。这些因素包括年龄，性别,身体质量指数,美国麻醉医师学会分类，合并症,用药史,操作持续时间,流体平衡,失血,尿量,和血气参数。IPH定义为持续平均动脉压<65mmHg，尽管需要额外的脱氧肾上腺素和液体治疗，但需要长时间输注脱氧肾上腺素>30分钟。
结果：在1596例PD患者中，661人（41.42%）经历了IPH。多变量逻辑回归确定了关键风险因素：年龄增加[比值比（OR）：每十年1.20，95%置信区间（CI）：1.08-1.33]（P<0.001），手术持续时间更长(OR：每小时1.15，95CI：1.05-1.26）（P<0.01），和更大的失血量(OR：每250毫升增加1.18，95CI：1.06-1.32）（P<0.01）。一个新的发现是动脉血Ca2+<1.05mmol/L与IPH（OR：2.03，95CI：1.65-2.50）（P<0.001）。
结论：PD期间的IPH与年龄无关，长时间的手术,失血量增加,和较低的血浆Ca2+。
