{"title":"术前测量脉搏波速度能否预测高血压患者麻醉诱导时的低血压?","authors":"Sinan Yılmaz, Imran Kurt Ömürlü","doi":"10.5144/0256-4947.2023.154","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>During the induction of general anesthesia, hemodynamic instability is a common occurrence in elderly hypertensive patients with increased arterial stiffness, which can cause undesirable complications. Pulse wave velocity (PWV) is an important indicator of arterial stiffness.</p><p><strong>Objectives: </strong>Investigate if preoperatively measured PWV is related to hemodynamic changes during induction of general anesthesia.</p><p><strong>Design: </strong>Prospective, case control.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Patients and methods: </strong>The study was carried out between December 2018 and December 2019 in patients 50 years or older scheduled for elective otolaryngology with endotracheal intubation and who had an American Society of Anesthesiologists (ASA) score of I or II. Patients diagnosed with hypertension (HT) or receiving treatment for hypertension for systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg were compared with non-hypertensive patients (non-HT) of matching age and gender.</p><p><strong>Main outcome measures: </strong>PWV values between HT and non-HT patients and hypotension rates at the 30th second of induction, the 30th second of intubation, and the 90th second of intubation between the HT and non-HT groups.</p><p><strong>Sample size: </strong>139 (95 with HT and 44 non-HT) RESULTS: PWV was higher in the HT group than in the non-HT group (<i>P</i><.001). Hypotension at the 30th second of intubation in the HT group was significantly more frequent than in the non-HT group (<i>P</i>=.025). PWV was higher in hypotensive (n=62) than in non-hypotensive patients but the difference was statistically significant only for PWV measured at 30th second of intubation (n=77) (<i>P</i>=.018).</p><p><strong>Conclusions: </strong>The easily and non-invasively measured preoperative PWV may be an effective means of predicting hypotension during the induction of general anesthesia at the 30th second of intubation in HT patients.</p><p><strong>Limitations: </strong>Numbers of patients in the groups were not the same, and the study was not sufficiently powered to investigate the effect of hypertensive medications on PWV and arterial stiffness.</p><p><strong>Conflict of interest: </strong>None.</p>","PeriodicalId":8016,"journal":{"name":"Annals of Saudi Medicine","volume":null,"pages":null},"PeriodicalIF":1.5000,"publicationDate":"2023-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/5a/0256-4947.2023.154.PMC10317492.pdf","citationCount":"0","resultStr":"{\"title\":\"Can pulse wave velocity measured preoperatively predict hypotension in hypertensive patients during anesthesia induction?\",\"authors\":\"Sinan Yılmaz, Imran Kurt Ömürlü\",\"doi\":\"10.5144/0256-4947.2023.154\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>During the induction of general anesthesia, hemodynamic instability is a common occurrence in elderly hypertensive patients with increased arterial stiffness, which can cause undesirable complications. Pulse wave velocity (PWV) is an important indicator of arterial stiffness.</p><p><strong>Objectives: </strong>Investigate if preoperatively measured PWV is related to hemodynamic changes during induction of general anesthesia.</p><p><strong>Design: </strong>Prospective, case control.</p><p><strong>Setting: </strong>University hospital.</p><p><strong>Patients and methods: </strong>The study was carried out between December 2018 and December 2019 in patients 50 years or older scheduled for elective otolaryngology with endotracheal intubation and who had an American Society of Anesthesiologists (ASA) score of I or II. Patients diagnosed with hypertension (HT) or receiving treatment for hypertension for systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg were compared with non-hypertensive patients (non-HT) of matching age and gender.</p><p><strong>Main outcome measures: </strong>PWV values between HT and non-HT patients and hypotension rates at the 30th second of induction, the 30th second of intubation, and the 90th second of intubation between the HT and non-HT groups.</p><p><strong>Sample size: </strong>139 (95 with HT and 44 non-HT) RESULTS: PWV was higher in the HT group than in the non-HT group (<i>P</i><.001). Hypotension at the 30th second of intubation in the HT group was significantly more frequent than in the non-HT group (<i>P</i>=.025). PWV was higher in hypotensive (n=62) than in non-hypotensive patients but the difference was statistically significant only for PWV measured at 30th second of intubation (n=77) (<i>P</i>=.018).</p><p><strong>Conclusions: </strong>The easily and non-invasively measured preoperative PWV may be an effective means of predicting hypotension during the induction of general anesthesia at the 30th second of intubation in HT patients.</p><p><strong>Limitations: </strong>Numbers of patients in the groups were not the same, and the study was not sufficiently powered to investigate the effect of hypertensive medications on PWV and arterial stiffness.</p><p><strong>Conflict of interest: </strong>None.</p>\",\"PeriodicalId\":8016,\"journal\":{\"name\":\"Annals of Saudi Medicine\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.5000,\"publicationDate\":\"2023-05-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/fd/5a/0256-4947.2023.154.PMC10317492.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Annals of Saudi Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.5144/0256-4947.2023.154\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"MEDICINE, GENERAL & INTERNAL\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Annals of Saudi Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.5144/0256-4947.2023.154","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"MEDICINE, GENERAL & INTERNAL","Score":null,"Total":0}
引用次数: 0
摘要
背景:在全麻诱导过程中，血流动力学不稳定是老年高血压患者动脉僵硬度增高的常见现象，可引起不良并发症。脉搏波速(PWV)是动脉刚度的重要指标。目的:探讨术前测量的PWV是否与全身麻醉诱导过程中的血流动力学变化有关。设计:前瞻性，病例对照。单位:大学医院。患者和方法:该研究于2018年12月至2019年12月期间在50岁或以上的患者中进行，这些患者计划接受气管插管的选择性耳鼻喉科，并且美国麻醉医师学会(ASA)评分为I或II。将收缩压(SBP)≥140 mm Hg和/或舒张压≥90 mm Hg诊断为高血压(HT)或接受高血压治疗的患者与年龄和性别相匹配的非高血压患者(非HT)进行比较。主要观察指标:HT组与非HT组患者诱导第30秒、插管第30秒、插管第90秒时的PWV值及低血压率。结果:HT组PWV明显高于非HT组(PP= 0.025)。降压组PWV (n=62)高于非降压组，但仅在插管第30秒测量PWV (n=77)差异有统计学意义(P= 0.018)。结论:简便、无创的术前PWV测量可作为预测HT患者插管30秒全麻诱导低血压的有效手段。局限性:两组患者数量不相同，该研究没有足够的动力来调查高血压药物对PWV和动脉僵硬的影响。利益冲突:无。
Can pulse wave velocity measured preoperatively predict hypotension in hypertensive patients during anesthesia induction?
Background: During the induction of general anesthesia, hemodynamic instability is a common occurrence in elderly hypertensive patients with increased arterial stiffness, which can cause undesirable complications. Pulse wave velocity (PWV) is an important indicator of arterial stiffness.
Objectives: Investigate if preoperatively measured PWV is related to hemodynamic changes during induction of general anesthesia.
Design: Prospective, case control.
Setting: University hospital.
Patients and methods: The study was carried out between December 2018 and December 2019 in patients 50 years or older scheduled for elective otolaryngology with endotracheal intubation and who had an American Society of Anesthesiologists (ASA) score of I or II. Patients diagnosed with hypertension (HT) or receiving treatment for hypertension for systolic blood pressure (SBP) ≥140 mm Hg and/or diastolic blood pressure ≥90 mm Hg were compared with non-hypertensive patients (non-HT) of matching age and gender.
Main outcome measures: PWV values between HT and non-HT patients and hypotension rates at the 30th second of induction, the 30th second of intubation, and the 90th second of intubation between the HT and non-HT groups.
Sample size: 139 (95 with HT and 44 non-HT) RESULTS: PWV was higher in the HT group than in the non-HT group (P<.001). Hypotension at the 30th second of intubation in the HT group was significantly more frequent than in the non-HT group (P=.025). PWV was higher in hypotensive (n=62) than in non-hypotensive patients but the difference was statistically significant only for PWV measured at 30th second of intubation (n=77) (P=.018).
Conclusions: The easily and non-invasively measured preoperative PWV may be an effective means of predicting hypotension during the induction of general anesthesia at the 30th second of intubation in HT patients.
Limitations: Numbers of patients in the groups were not the same, and the study was not sufficiently powered to investigate the effect of hypertensive medications on PWV and arterial stiffness.
期刊介绍：
The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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