术内低血压是脊柱融合手术中重大并发症的重要可修改风险因素
Steven D Glassman1, Leah Y Carreon1, Mladen Djurasovic1
1Norton Leatherman Spine Center, Louisville, KY.
Spine
|May 8, 2024
概括
在脊椎手术的第一个小时内,手术内低血压 (IOH) 显著增加了术后并发症的风险. 早期控制血压对于在胸腔关融合中获得更好的患者结果至关重要.
科学领域:
- 神经外科 神经外科
- 麻醉学 麻醉学
- 脊柱外科手术 脊柱外科手术
背景情况:
- 术内低血压 (IOH),定义为平均动脉压 (MAP) <65 mm Hg,与急性损伤等一般手术中的不良结果有关.
- 在脊柱形手术中,IOH可以在正过程中对脊髓功能和神经监测产生负面影响.
研究的目的:
- 为了调查手术内低血压 (IOH) 和手术后并发症在主要胸脊柱融合程序之间的关联.
- 确定IOH的时间和持续时间是否会影响术后并发症的发生和严重程度.
主要方法:
- 一个追溯的观察性队列研究,对539个胸融合病例 (≥6级,持续时间>3小时) 进行了观察.
- 收集了详细的麻醉和手术数据,包括分钟一分钟的MAP,血管压缩剂的使用和流体管理.
- 在第一个小时和整个手术期间,IOH (<65毫米平) 的量化累积持续时间,与术后并发症率相关.
主要成果:
- 在第一个手术小时内IOH的持续时间和整体术后并发症 (8.2比5.6分钟,P<0.001) 之间发现了显著的关联.
- 这种相关性扩展到整个手术 (28.1比19.3分钟,P=0.008) 和特定的并发症,如手术部位感染,呼吸衰竭和认知功能障碍.
- 患有更多并发症的患者经历了更长的IOH持续时间,并接受了更多的血管压缩剂.
结论:
- 在多层腰部融合手术的最初一小时内,手术内低血压的持续时间是重大术后并发症的关键,可修改的风险因素.
- 在胸脊椎手术期间早期的血压管理可以减轻不良结果的风险.
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