术内低血压轨迹及其对重大术后并发症的预测价值:一个回顾性队列研究
Yingbo Ren1, Chang Liu1, Xin Wang1
1Department of Anesthesiology, The Affiliated Traditional Chinese Medicine Hospital, Southwest Medical University, Luzhou, China.
Frontiers in medicine
|January 30, 2026
概括
术内低血压 (IOH) 的明显模式预测了术后并发症. 识别这些血压轨迹可以改善风险预测,超出了对高风险手术患者的标准措施.
科学领域:
- 麻醉学和外科手术期间的医学.
- 心血管生理学心血管生理学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 术内低血压 (IOH) 是主要非心脏手术期间的常见并发症.
- 在IOH期间不同时间血压模式的预后意义尚不清楚.
- 高风险的手术患者需要精确的风险分层对不良的术后结果.
研究的目的:
- 使用基于组的轨迹建模 (GBTM) 识别不同的手术内低血压 (IOH) 轨迹.
- 评估这些IOH轨迹对于重大术后并发症的独立和增量预测价值.
- 为了加强接受重大非心脏手术的高风险手术患者的风险分层.
主要方法:
- 789名接受重大非心脏手术的成年患者的回顾性队列研究.
- 使用GBTM分析分钟平均动脉压 (MAP) 数据,以定义IOH轨迹 (暂时轻度,中度持续,延长/波动).
- 多变量后勤回归和ROC分析评估了IOH轨迹与重大术后并发症的复合结果之间的关联.
主要成果:
- 在IOH轨迹中增加并发症率的显著趋势:13.4% (暂时轻微),20.8% (中度持续) 和30.7% (持续/波动).
- 与短暂的轻微IOH相比,持久/波动IOH轨迹显示出明显更高的并发症调整几率比率 (aOR 2.42).
- 将IOH轨迹纳入临床模型显著改善了预测歧视 (AUC 0.860与0.578) 和校准.
结论:
- 明显的手术内低血压轨迹与严重的术后并发症密切相关.
- 基于轨迹的血液动力学分析显著提高了超越传统IOH指标的预测准确性.
- 这种方法可以促进个性化的血压管理和早期的外科手术风险分层.
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