低血压预测指数在非心脏手术中的有效性:系统性审查,元分析和试验顺序分析
Vitor Alves Felippe1, Ana C Pinho1, Lucas M Barbosa2
1Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil.
Brazilian journal of anesthesiology (Elsevier)
|June 12, 2025
概括
低血压预测指数 (HPI) 有效地减少了非心脏手术中的手术内低血压 (IOH) 持续时间和严重程度. 虽然HPI的使用显示了好处,但它并没有显著改变不良事件或烯的使用.
科学领域:
- 麻醉学和重症监护医学
- 在外科手术期间的医学.
- 医疗器械技术 医疗器械技术
背景情况:
- 低血压预测指数 (HPI) 在缓解非心脏手术期间手术内低血压 (IOH) 的临床有效性尚未得到充分证实.
- 进行了系统性审查,元分析和试验序列分析,以评估HPI在接受非心脏手术的成年患者的疗效.
研究的目的:
- 确定低血压预测指数 (HPI) 是否有效降低非心脏手术的成年患者的手术内低血压 (IOH).
- 综合来自随机对照试验 (RCT) 的证据,比较HPI指导治疗与标准护理.
主要方法:
- 对相关RCT进行了PubMed,Embase和Cochrane数据库的全面搜索.
- 通过使用平均差异 (MD) 和风险比率 (RR) 和95%信心区间 (CI) 进行了元分析.
- 使用R软件 (版本4.2.3) 进行统计分析.
主要成果:
- 分析了11个涉及789名患者的RCT,其中395人接受了HPI指导管理.
- HPI显著降低了平均动脉压 (MAP) <65 mmHg的时间加权平均值 (TWA) 和曲线下的面积 (AUC).
- 此外,HPI还降低了每位患者低血压事件的持续时间和数量,而低血压事件,烯使用或AKI发生率没有显著差异.
结论:
- 使用HPI与非心脏手术中手术内低血压 (IOH) 的持续时间和严重程度的显著减少有关.
- 在HPI指导治疗和标准护理之间没有观察到不良事件的显著差异.
- 限制包括研究异质性,HPI实施的变化以及缺乏长期结果数据.
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