63.术中血压波动与颈椎手术术后 C5 麻痹相关：一项回顾性观察研究

Q3 Medicine

North American Spine Society Journal Pub Date : 2024-07-01 DOI:10.1016/j.xnsj.2024.100401

Toshiki Tsukui MD , Eiji Takasawa MD, PhD , Hirotaka Chikuda MD, PhD

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引用次数: 0

摘要

背景背景术后 C5 麻痹是颈椎手术后一种公认的并发症。然而，鉴于其多因素性质，确切的病理生理学仍存在争议。我们重点研究了术中动脉血压（IO-MAP），它代表了手术过程中全身血液动力学的改变。我们假设 IO-MAP 变化可能会影响术后 C5 麻痹的发生率。本研究旨在探讨颈椎手术期间 IO-MAP 变化与 C5 麻痹发生率之间的关系。我们的队列包括 74 名患有颈椎脊髓病（CSM）、后纵韧带骨化（OPLL）或其他颈椎病变的患者。结果测量术中 IO-MAP 连续≥5 次下降至 65 mmHg 即为术后低血压，这与心肌梗死、急性肾损伤和死亡率等不良术后结果有关。方法将患者分为有或没有 C5 麻痹的两组（C5 麻痹组与年龄匹配的对照组）。记录人口统计学特征、诊断、手术特征和 IO-MAP 参数。结果74例患者（平均年龄70.5岁；22例[30%]女性）中，13例（17.6%）出现术后C5麻痹。两组患者的年龄、性别、诊断（OPLL 23% vs 18%）、脊柱融合率（54% vs 33%）和术中低血压发生率（每例手术 2.5 vs 3.1 次）相当（P > 0.05）。然而，与对照组相比，C5 麻痹患者的 IO-MAP 振幅更大（Δ92 vs Δ73 mmHg，P = 0.013）。调整混杂因素后，IO-MAP 振幅仍是术后 C5 麻痹的独立风险因素（几率比 1.03，95% 置信区间 1.00-1.05，P = 0.03）。ROC 分析发现，IO-MAP 波幅临界值为 Δ67mmHg 时，预测 C5 麻痹的灵敏度为 85%，特异度为 53%（AUC 0.72，95% CI 0.56-0.87）。我们的研究结果强调了最佳血流动力学控制对降低 C5 麻痹风险的重要性。最大和最小 IO-MAP 值之间的差距应保持在 67 mmHg 以下。FDA 设备/药物状态本摘要未讨论或包含任何适用的设备或药物。

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63. Intraoperative blood pressure fluctuation is associated with postoperative C5 palsy in cervical spine surgery: a retrospective observational study

BACKGROUND CONTEXT

Postoperative C5 palsy is a well-recognized complication following cervical spine surgery. However, the precise pathophysiology remains debated given its multifactorial nature. We focused on intraoperative arterial blood pressure (IO-MAP) as a representation of systemic hemodynamic alterations during surgery. We hypothesized that IO-MAP changes may influence the incidence of postoperative C5 palsy.

PURPOSE

This study aimed to investigate the relationship between IO-MAP changes during cervical spine surgery and the occurrence of C5 palsy.

STUDY DESIGN/SETTING

This was a retrospective single-center cohort study. Surgical records were reviewed to identify all patients undergoing cervical spine surgery at our institution from 2010 to 2022.

PATIENT SAMPLE

Our cohort included 74 patients with cervical spondylotic myelopathy (CSM), ossification of the posterior longitudinal ligament (OPLL), or other cervical pathologies.

OUTCOME MEASURES

Intraoperative hypotension was defined as ≥5 consecutive drops in IO-MAP to <65 mmHg during surgery, which has been associated with adverse postoperative outcomes like myocardial infarction, acute kidney injury, and mortality. The IO-MAP amplitude was calculated as the difference between maximum and minimum IO-MAP values.

METHODS

Patients were divided into groups with or without C5 palsy (C5 palsy group vs age-matched control group). Demographics, diagnosis, surgical characteristics, and IO-MAP parameters were recorded. Multivariable logistic regression identified independent risk factors for postoperative C5 palsy.

RESULTS

Among 74 patients (mean age 70.5 years; 22 [30%] female), 13 (17.6%) developed postoperative C5 palsy. Age, sex, diagnosis (OPLL 23% vs 18%), spinal fusion rate (54% vs 33%), and intraoperative hypotension incidence (2.5 vs 3.1 episodes per surgery) were comparable between groups (P > 0.05). However, patients with C5 palsy had greater IO-MAP amplitude versus controls (Δ92 vs Δ73 mmHg, P = 0.013). After adjusting for confounders, IO-MAP amplitude remained an independent risk factor for postoperative C5 palsy (odds ratio 1.03, 95% confidence interval 1.00-1.05, P = 0.03). ROC analysis found an IO-MAP amplitude cutoff of Δ67mmHg predicted C5 palsy with 85% sensitivity and 53% specificity (AUC 0.72, 95% CI 0.56-0.87).

CONCLUSIONS

Intraoperative MAP amplitude was closely associated with postoperative C5 palsy occurrence. Our findings emphasize the importance of optimal hemodynamic control to mitigate C5 palsy risk. The gap between maximum and minimum IO-MAP values should be maintained below 67 mmHg.