术内低血压和术后ICU妄想之间的关联:一个回顾性观察性研究
Shohei Ono1,2, Yusuke Iizuka3, Taishi Saito1
1Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 847 Amanuma-Cho, Omiya-Ku, Saitama, 330-8503, Japan.
Journal of anesthesia
|October 21, 2025
概括
术内低血压 (IOH) 在高风险的手术患者中显著增加了术后狂妄的风险. 在手术期间保持警的血压管理对于预防这种常见并发症至关重要.
科学领域:
- 麻醉学和外科手术期间的医学.
- 关键护理医学 关键护理医学
- 神经外科 神经外科
背景情况:
- 手术后妄想是手术后常见的并发症,与长时间住院和死亡等不良结果有关.
- 术后低血压 (IOH) 是术后狂妄的潜在可改变的危险因素,但证据仍然不一致.
- 高风险的手术患者,包括老年人和患有并发病的人,特别容易患上术后妄想症.
研究的目的:
- 评估手术内低血压 (IOH) 与手术后重症监护室 (ICU) 在48小时内 Delirium 的发生之间的关联.
- 确定IOH的特定指标,如低血压区域和时间,与妄想风险相关.
- 在高风险的手术群体中研究潜在的效果修饰剂.
主要方法:
- 这是一项单一中心的回顾性研究,涉及2017年至2024年期间接受非心肺绕道全身麻醉的高风险成年患者.
- 量化IOH使用累积面积和总时间,平均动脉压 (MAP) 低于65mmHg.
- 多变量逻辑回归分析,根据相关的共变量进行调整,并进行子组和相互作用分析.
主要成果:
- 无论是低血压区域 (OR 1.16) 还是低血压时间 (OR 3.42) 都与手术后的ICU狂妄症在48小时内显著相关.
- 在包括老年患者,ASA-PS得分较高的患者,吸入麻醉,神经外科和ICU输管等子组中观察到更强烈的关联.
- 这些发现表明IOH暴露和妄想风险之间存在剂量依赖的关系.
结论:
- 术内低血压是高风险手术患者术后ICU狂妄症的重要预测因素.
- 在手术期间密切监测和控制血压对于减轻妄想风险至关重要.
- 需要进行进一步的干预研究,以建立针对IOH诱导的妄的预防策略.
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