目的:越来越多的证据表明,血压管理可能与心脏手术后的终末器官功能障碍有关。本研究旨在探讨术中低血压(IOH)对不良神经系统预后和死亡率的影响。
方法:单中心回顾性队列研究。
方法:心脏和糖尿病中心BadOeynhausenNRW,鲁尔-波鸿大学.
方法:这项回顾性队列研究纳入了31,315名在2009年1月至2018年12月期间在作者机构接受择期心脏手术的成年患者。
方法:除辅助装置植入外的所有心脏手术,器官移植,紧急手术。
结果:神经系统不良结局定义为术后谵妄和卒中。IOH定义为平均动脉压低于60mmHg持续>2分钟。记录IOH发作的频率和累积IOH持续时间。通过未调整的统计分析和多元逻辑回归分析检查了IOH与不良神经系统结局之间的关联。八百四十九名(百分之二点九)病人发生术后中风,2,401例(7.7%)患者发生术后谵妄。在多元逻辑回归分析中,IOH发作频率与术后谵妄独立相关(比值比1.02,95%CI1.003-1.03,p<0.001),而它与卒中之间没有关联.
结论:这项大型回顾性单中心队列研究表明,心脏手术后IOH发作的增加与发生术后谵妄的风险相关。这可能对仔细和精确的血流动力学监测和积极治疗具有重要的临床意义。尤其是术后谵妄风险增加的患者。
OBJECTIVE: There is accumulating evidence that blood pressure management might be associated with end-organ dysfunction after cardiac surgery. This
study aimed to investigate the impact of intraoperative hypotension (IOH) on adverse neurologic outcomes and mortality.
METHODS: A single-center retrospective cohort
study.
METHODS: The Heart and Diabetes Centre Bad Oeynhausen NRW, Ruhr-University Bochum.
METHODS: This retrospective cohort
study included 31,315 adult patients who underwent elective cardiac surgery at the authors\' institution between January 2009 and December 2018.
METHODS: All cardiac surgery procedures except assist device implantation, organ transplantation, and emergency surgery.
RESULTS: Adverse neurologic outcomes were defined as postoperative delirium and stroke. IOH was defined as mean arterial pressure below 60 mmHg for >2 minutes. The frequency of IOH episodes and the cumulative IOH duration were recorded. The association between IOH and adverse neurologic outcomes was examined with unadjusted statistical analysis and multiple logistic regression analysis. Eight hundred forty-nine (2.9%) patients developed postoperative stroke, and 2,401 (7.7%) patients developed postoperative delirium. The frequency of IOH episodes was independently associated with postoperative delirium in the multiple logistic regression analysis (odds ratio 1.02, 95% CI 1.003-1.03, p < 0.001), whereas there was no association between it and stroke.
CONCLUSIONS: This large retrospective monocentric cohort
study revealed that increased episodes of IOH were associated with the risk of developing postoperative delirium after cardiac surgery. This might have important clinical implications with respect to careful and precise hemodynamic monitoring and proactive treatment, especially in patients with increased risk for postoperative delirium.