术后低血压对手术患者不良临床结局的影响：系统回顾和荟萃分析

IF 5.1 2区医学 Q1 ANESTHESIOLOGY

Journal of Clinical Anesthesia Pub Date : 2025-08-30 DOI:10.1016/j.jclinane.2025.111987

Shunyu Han , Tao Zeng , Yumei Xie , Chang Liu , Lina Yang , Mengchang Yang

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引用次数: 0

摘要

术后低血压（POH）是多器官发病的独立预测因子。新出现的证据表明其风险超过术中低血压（IOH）相关的风险。考虑到手术环境中这种病理生理障碍的普遍存在，我们的荟萃分析评估了POH与主要不良后果之间的关系。方法系统检索PubMed、Web of Science、Cochrane Library和Embase，检索截至2025年2月7日的POH和不良后果的临床研究。随访期间的死亡率被指定为主要结局。次要结局包括急性肾损伤（AKI）、心肌损伤、谵妄、中风和术后住院时间（LOS）。采用Egger检验和补齐分析评估发表偏倚；敏感性分析采用留一法；并进行亚组分析，探讨异质性。本荟萃分析纳入了23项研究，涉及262,435例患者。POH与不良结局之间存在显著关联，包括死亡率（OR = 2.51, 95%可信区间[CI] 1.86-3.38）、AKI （OR = 1.72, 95% CI 1.25-2.36）、心肌损伤（OR = 2.52, 95% CI 1.71-3.69）和卒中（OR = 1.82, 95% CI 1.09-3.05）。然而，通过修整和填充方法检测到的发表偏倚损害了AKI结果的稳健性，而卒中相关性在遗漏敏感性分析中表现出不稳定性。亚组分析确定多个POH阈值是异质性的主要来源。结论POH与术后死亡率和心肌损伤有显著相关性。然而，POH与AKI和卒中的关联表现出有限的稳健性，需要进一步研究。未来的研究必须描述POH深度、持续时间和测量方法的影响。

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The effect of postoperative hypotension on surgical patients' adverse clinical outcomes: A systematic review and meta-analysis

Introduction

Postoperative hypotension (POH) represents an independent predictor of multiorgan morbidity. Emerging evidence indicates its risks exceed those associated with intraoperative hypotension (IOH). Considering the ubiquitous presence of this pathophysiological disturbance across surgical settings, our meta-analysis evaluates associations between POH and major adverse outcomes.

Methods

We systematically searched PubMed, Web of Science, Cochrane Library, and Embase for clinical studies investigating POH and adverse outcomes, with literature coverage through 7 February 2025. Mortality during follow-up was designated as the primary outcome. Secondary outcomes included acute kidney injury (AKI), myocardial injury, delirium, stroke, and postoperative length of stay (LOS). Publication bias was assessed using Egger's test and trim-and-fill analysis; sensitivity analyses employed the leave-one-out method; and subgroup analysis was performed to explore heterogeneity.

Results

This meta-analysis incorporated 23 studies involving 262,435 patients. Significant associations were identified between POH and adverse outcomes, including mortality (OR = 2.51, 95 % confidence interval [CI] 1.86–3.38), AKI (OR = 1.72, 95 % CI 1.25–2.36), myocardial injury (OR = 2.52, 95 % CI 1.71–3.69), and stroke (OR = 1.82, 95 % CI 1.09–3.05). However, publication bias detected by the trim-and-fill method compromised the robustness of AKI findings, while the stroke association demonstrated instability in leave-one-out sensitivity analyses. Subgroup analyses identified multiple POH thresholds as the primary source of heterogeneity.

Conclusion

These findings establish POH as a clinically significant correlate of postoperative mortality and myocardial injury. However, POH associations with AKI and stroke exhibit limited robustness, requiring further investigation. Future studies must delineate the impact of POH depth, duration, and measurement method.

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.