目的:使用无创血压(NIBP)监测的左心室辅助装置(LVAD)患者的血流动力学评估在没有脉动血流的情况下可能不可靠。这项研究的主要目的是检查在诱导时使用NIBP监测仪进行非心脏手术的患者中,10分钟或更长时间的术中血压监测间隙与LVAD类型之间的关联。
方法:回顾性队列。
方法:单一机构,学术大学医院。
方法:一百一十十五名患者接受187例非心脏手术,在诱导时没有动脉导管。
方法:非心脏手术。
方法:主要结果是血压监测差距的关联,被定义为十分钟或更长时间,和LVAD类型,包括HeartMate2(HM2;雅培,芝加哥,IL)和HeartMate3(HM3;雅培,芝加哥,IL),通过多变量逻辑回归分析评估。
结果:调整患者特征后,HM3与较低的监测差距几率相关(p=0.02)。此外,病态肥胖患者出现监测间隙的几率较高(p=0.04),手术时间超过180min(p=0.001).在事后分析中,病态肥胖,全身麻醉,并且发现长时间手术与诱导后动脉管路放置的几率增加相关(p=0.05,p=0.007,p<0.001)。
结论:接受非心脏手术的HM2患者与HM3患者相比,血压监测间隔为10分钟或更大的几率高出近3倍。病态肥胖和手术时间延长也与监测差距的显着增加有关。病态肥胖,全身麻醉,和更长的手术时间被发现有更大的可能性动脉导管在诱导后放置。这些结果可能有助于麻醉师确定NIBP在接受非心脏手术的LVAD患者中的适当性。
OBJECTIVE: The hemodynamic assessment of patients with left ventricular assist devices (LVAD) using noninvasive blood pressure (NIBP) monitoring may be unreliable without pulsatile blood flow. The primary goal of this study is to examine the association between intraoperative blood pressure monitoring gaps of 10 min or greater and LVAD type in patients undergoing noncardiac surgeries with NIBP monitors at induction.
METHODS: Retrospective cohort.
METHODS: Single institution, academic university hospital.
METHODS: One-hundred fifteen patients undergoing 187 noncardiac surgeries without arterial lines at induction.
METHODS: Noncardiac surgery.
METHODS: The primary outcome was the association of blood pressure monitoring gaps, which were defined as ten minutes or greater, and LVAD type including the HeartMate 2 (HM2; Abbott, Chicago, IL) and the HeartMate 3 (HM3; Abbott, Chicago, IL), as evaluated by multivariable logistic regression analysis.
RESULTS: After adjusting for patient characteristics, HM3 was associated with lower odds of monitoring gaps (p = 0.02). Additionally, the odds of a monitoring gap were higher in patients with morbid obesity (p = 0.04) and in surgical duration longer than 180 min (p = 0.001). In the post-hoc analysis, morbid obesity, general anesthesia, and prolonged surgeries were found to be associated with increased odds of arterial line placement after induction (p = 0.05, p = 0.007, p < 0.001).
CONCLUSIONS: Patients with a HM2 undergoing noncardiac surgery had nearly three-fold higher odds of blood pressure monitoring gaps of 10 min or greater compared to patients with a HM3. Morbid obesity and prolonged surgical duration were also associated with a significant increase in monitoring gaps. Morbid obesity, general anesthesia, and longer surgical duration were found to have a greater odds of arterial line placement after induction. These results may help anesthesiologists determine the appropriateness of NIBP in patients with LVADs undergoing noncardiac surgeries.