内科手术血压:更低可以更高吗?
Frederic Michard1, Alexandre Joosten2, Emmanuel Futier3
1MiCo, Vallamand, Switzerland.
British journal of anaesthesia
|October 1, 2023
概括
通过准较低的平均动脉压 (≤60 mm Hg) 来预防手术内低血压并没有增加术后并发症. 低血压可能表明患者的脆弱性,而不是导致不良结果.
科学领域:
- 麻醉学 麻醉学
- 关键护理医学 关键护理医学
- 手术结果研究研究.
背景情况:
- 观察性研究表明,手术内低血压与术后发病率增加之间存在联系.
- 仍然没有证实因果关系;预防低血压是否改善结果是未知的.
研究的目的:
- 对随机试验进行元分析,评估低与高的平均动脉压目标对术后结果的影响.
- 为了确定手术期间针对较低的平均动脉压 (≤60 mm Hg) 是否会增加患者的发病率和死亡率.
主要方法:
- 对10项前性随机试验的元分析.
- 在麻醉和手术期间,低 (≤60 mm Hg) 与较高的平均动脉压 (MAP) 目标的比较.
主要成果:
- 在低MAP目标群体中,术后发病率和死亡率没有显著增加.
- 从统计学上显著,但从临床上没有意义,手术后心律不整和住院时间的减少,MAP ≤60 mm Hg.
结论:
- 术后低血压可能作为患者严重程度或脆弱性的标志物,而不是术后并发症的直接原因.
- 针对较低的MAP (≤60 mm Hg) 似乎是安全的,并且可能在特定的术后结果中提供轻微的好处.
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