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Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study

文献类型：期刊论文

作者Wang, Juan6; Lin, Fa5; Zeng, Min6; Liu, Minying6; Zheng, Maoyao6; Ren, Yue6; Li, Shu6; Yang, Xiaodong4; Chen, Yiqiang4; Chen, Xiaolin1,5
刊名INTERNATIONAL JOURNAL OF SURGERY
出版日期2024-02-01
卷号110期号:2页码:965-973
关键词anesthesia aneurysmal subarachnoid hemorrhage cardiac complications hypotension
ISSN号1743-9191
DOI10.1097/JS9.0000000000000928
英文摘要Background: Previous studies report that intraoperative hypotension worsens outcomes after aneurysmal subarachnoid hemorrhage (aSAH). However, the hypotensive harm threshold for major adverse cardiovascular events (MACE) remains unclear. Methods: The authors included aSAH patients who had general anesthesia for aneurysmal clipping/coiling. MACE were defined by a composite of acute myocardial injury, acute myocardial infarction, and other cardiovascular complications identified by electrocardiogram and echocardiography. The authors initially used logistic regression and change-point analysis based on the second derivative to identify mean arterial pressure (MAP) of 75 mmHg as the harm threshold. Thereafter, our major exposure was MAP below 75 mmHg characterized by area, duration, and time-weighted average. The area below 75 mmHg represents the severity and duration of exposure and was defined as the sum of all areas below a specified threshold using the trapezoid rule. Time-weighted average MAP was derived by dividing area below the threshold by the duration of anesthesia. All analyses were adjusted for baseline risk factors including age greater than 70 years, female sex, severity of intracerebral hemorrhage, history of cardiovascular disease, and preoperative elevated myocardial enzymes. Results: Among 1029 patients enrolled, 254 (25%) developed postoperative MACE. Patients who experienced MACE were slightly older (59 +/- 11 vs. 54 +/- 11 years), were slightly more often women (69 vs. 58%), and had a higher prevalence of cardiovascular history (65 vs. 47%). Adjusted cardiovascular risk increased nearly linearly over the entire range of observed MAP. However, there was a slight inflexion at MAP of 75 mmHg. MACE was significantly associated with area [adjusted odds ratios (aOR) 1.004 per 10 mmHg.min, 95% CI: 1.001-1.007, P =0.002), duration (aOR 1.031 per 10 min, 95% CI: 1.009-1.054, P =0.006), and time-weighted average (aOR 3.516 per 10 mmHg, 95% CI: 1.818-6.801, P <0.001) of MAP less than 75 mmHg. Conclusions: Lower blood pressures were associated with cardiovascular complications over the entire observed range, but worsened when MAP was less than 75 mmHg. Pending trial data to establish causality, it may be prudent to keep MAP above 75 mmHg in patients having surgical aSAH repairs to reduce the risk of MACE.
资助项目Beijing Municipal Science & Technology Commission[Z191100006619068]
WOS研究方向Surgery
语种英语
WOS记录号WOS:001164676800038
出版者LIPPINCOTT WILLIAMS & WILKINS
源URL[http://119.78.100.204/handle/2XEOYT63/38840]  
专题中国科学院计算技术研究所期刊论文_英文
通讯作者Chen, Xiaolin; Peng, Yuming
作者单位1.Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, 119 Nansihuan Xilu, Beijing 100160, Peoples R China
2.Outcome Res Consortium, Cleveland, OH USA
3.Cleveland Clin, Dept Outcome Res, Cleveland, OH USA
4.Chinese Acad Sci, Inst Comp Technol, Beijing, Peoples R China
5.Capital Med Univ, Beijing Tiantan Hosp, Dept Neurosurg, Beijing, Peoples R China
6.Capital Med Univ, Beijing Tiantan Hosp, Dept Anesthesiol, Beijing, Peoples R China
推荐引用方式
GB/T 7714		 Wang, Juan,Lin, Fa,Zeng, Min,et al. Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study[J]. INTERNATIONAL JOURNAL OF SURGERY,2024,110(2):965-973.
APA Wang, Juan.,Lin, Fa.,Zeng, Min.,Liu, Minying.,Zheng, Maoyao.,...&Peng, Yuming.(2024).Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study.INTERNATIONAL JOURNAL OF SURGERY,110(2),965-973.
MLA Wang, Juan,et al."Intraoperative blood pressure and cardiac complications after aneurysmal subarachnoid hemorrhage: a retrospective cohort study".INTERNATIONAL JOURNAL OF SURGERY 110.2(2024):965-973.

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来源：计算技术研究所

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