手術後の低血圧が手術患者の不良臨床結果に及ぼす影響: 系統的レビューとメタ解析
Shunyu Han1, Tao Zeng1, Yumei Xie1
1School of Clinical Medicine, Southwest Medical University, Luzhou 646000, China; Department of Anesthesiology, Qionglai Medical Center Hospital, Chengdu 611530, China.
Journal of clinical anesthesia
|August 31, 2025
まとめ
術後の低血圧は,死亡率と心筋損傷の増加と関連しています. 急性腎損傷と脳卒中との関連は,証拠の強さが限られているため,さらなる研究が必要である.
科学分野:
- 麻酔科 と 集中治療 科
- 手術 結果 研究
- 心血管・腎臓医学
背景:
- 術後の低血圧 (POH) は多臓器疾患の有意な予測因子であり,そのリスクは手術中の低血圧 (IOH) を上回る可能性があります.
- POHは様々な手術環境でよく見られる現象であり,その影響を徹底的に理解する必要があります.
- このメタ解析は,POHと主要な不良後の結果との関連に関する証拠を統合することを目的としています.
研究 の 目的:
- 術後低血圧 (POH) と主要な有害結果との関連性を評価する.
- 死亡率,急性腎臓損傷 (AKI),心筋損傷,脳卒中のリスクを定量化するために.
- 報告された関連性における潜在的な異質性の源を特定する.
主な方法:
- 2025年2月7日までのPubMed,Web of Science,Cochrane Library,およびEmbaseの体系的な文献検索を行いました.
- 262,435人の患者を含む23の研究のメタアナリシスで,主なアウトカムとして死亡率を挙げました.
- エッガーのテストとトリム・アンド・フィール分析を用いた出版バイアスの評価; 感度分析には"つを除外する方法が含まれ,サブグループ分析は異質性を調査した.
主要な成果:
- POHは死亡率 (OR=2. 51),心筋損傷 (OR=2.52) および脳卒中 (OR=1. 82) の増加と有意に関連していました.
- POHと急性腎損傷 (AKI) の間にも有意な関連性が見られた (OR=1. 72).
- 出版のバイアスにより,AKIの調査結果の信頼性が損なわれ,脳卒中との関連は感度分析において不安定であった. ヘテロゲニティは主にPOHの値と関連していた.
結論:
- 術後の低血圧は,手術後の死亡率と心筋損傷の重要な臨床相関因子である.
- POHとAKIと脳卒中との関連は 確固たるものではなく,さらなる調査が必要である.
- 将来の研究は,POHの深さ,持続時間,測定方法の影響を定義することに焦点を当てるべきです.
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