与标准血流动力学相比，以预测低血压指数为指导的监测和管理对减少术后低血压的影响

IF 0.8 Q3 ANESTHESIOLOGY

Revista Espanola de Anestesiologia y Reanimacion Pub Date : 2025-04-15 DOI:10.1016/j.redar.2025.501803

J. Ripollés-Melchor , P. Fernández-Valdés-Bango , D. García-López , M. Olvera-García , J.L. Tomé-Roca , C.A. Vargas-Berenjeno , A. Ruiz-Escobar , A.B. Adell-Pérez , L. Carrasco-Sánchez , A. Abad-Gurumeta , J.V. Lorente , A.V. Espinosa , I. Jiménez-López , M.A. Valbuena-Bueno , M.I. Monge-García

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引用次数: 0

摘要

术中低血压（IOH）是腹部大手术中常见的现象。IOH的严重程度和持续时间已被确定为这些并发症发生的关键因素。方法本研究比较了两组接受腹部大手术的成年患者：一组采用Edwards Flotrac装置进行标准的血流动力学管理，而第二组接受低血压预测指数持续时间和高危患者术中低血压严重程度（HPI）指导下的血流动力学管理，麻醉医师通过结构化的监护计划进行培训。我们回顾性分析了2021-2022年期间从6个西班牙中心收集的匿名数据。主要结局指标是手术期间平均动脉压65mmhg （MAP）的时间加权平均值（TWA MAP 65mmhg）。次要结局指标包括低血压发作的发生率、低血压总时间和手术期间低血压时间的百分比。结果共分析607例患者，监测前组270例，监测后组337例。中间两个地图65毫米汞柱是0.09毫米汞柱(四分位范围(差):0.00 - -0.31毫米汞柱)post-proctoring集团vs 0.37毫米汞柱(IQR: 0.08 - -1.01毫米汞柱)pre-proctoring组,0.19毫米汞柱的平均差异(95%置信区间:0.13—-0.27毫米汞柱,P & lt;措施),而中间两个地图& lt; 55毫米汞柱是0.00毫米汞柱(IQR: 0.00 - -0.01毫米汞柱)post-proctoring集团vs 0.00毫米汞柱(IQR: 0.00 - -0.07毫米汞柱)pre-proctoring集团0毫米汞柱(95%置信区间:0.0—-0.02毫米汞柱;P & lt;措施)。结论基于术中血流动力学预测指标的结构化血流动力学训练方案可降低发生率。

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Impacto de la supervisión y la gestión guiada por el índice de predicción de la hipotensión frente a la hemodinámica estándar en la reducción de la hipotensión intraoperatoria

Introduction

Intraoperative hypotension (IOH) is a commonly observed phenomenon during major abdominal surgery. The severity and duration of IOH have been identified as crucial factors in the development of these complications.

Methods

The study compares two groups of adult patients undergoing major abdominal surgery: one group received standard hemodynamic management using the Edwards Flotrac device, while the second group received hypotension prediction index duration, and severity of intraoperative hypotension in high-risk patients (HPI)-guided hemodynamic management, with anesthesiologists trained via a structured proctoring program. We retrospective analized prospectively gathered anonymized data from 6 Spanish centers during 2021-2022. The primary outcome measure was the time-weighted average of mean arterial pressure < 65 mmHg (MAP) during surgery (TWA MAP 65 mmHg). The secondary outcome measures included incidence of hypotensive episodes, total time with hypotension, and percentage of time spent in hypotension during surgery.

Results

A total of 607 patients were analyzed, 270 in the pre-proctoring group vs 337 in the post-proctoring group. The median TWA MAP 65 mmHg was 0.09 mmHg (interquartile range [IQR]: 0.00-0.31 mm Hg) post-proctoring group vs 0.37 mmHg (IQR: 0.08-1.01 mm Hg) in the pre-proctoring group, for a median difference of 0.19 mmHg (95% CI: 0.13-0.27 mmHg; P <.001), whereas the median TWA MAP < 55 mmHg was 0.00 mmHg (IQR: 0.00-0.01 mmHg) post-proctoring group vs 0.00 mmHg (IQR: 0.00-0.07 mm Hg) in the pre-proctoring group, 0 mmHg (95% CI: 0.0-0.02 mm Hg; P <.001).