医学
急性肾损伤
平均动脉压
血压
相对风险
麻醉
心脏病学
绝对风险降低
内科学
置信区间
心率
作者
Vafi Salmasi,Kamal Maheshwari,Dongsheng Yang,Edward J. Mascha,A. K. Singh,Daniel I. Sessler,Andrea Kurz
出处
期刊:Anesthesiology
[Ovid Technologies (Wolters Kluwer)]
日期:2017-01-01
卷期号:126 (1): 47-65
被引量:688
标识
DOI:10.1097/aln.0000000000001432
摘要
How best to characterize intraoperative hypotension remains unclear. Thus, the authors assessed the relationship between myocardial and kidney injury and intraoperative absolute (mean arterial pressure [MAP]) and relative (reduction from preoperative pressure) MAP thresholds.The authors characterized hypotension by the lowest MAP below various absolute and relative thresholds for cumulative 1, 3, 5, or 10 min and also time-weighted average below various absolute or relative MAP thresholds. The authors modeled each relationship using logistic regression. The authors further evaluated whether the relationships between intraoperative hypotension and either myocardial or kidney injury depended on baseline MAP. Finally, the authors compared the strength of associations between absolute and relative thresholds on myocardial and kidney injury using C statistics.MAP below absolute thresholds of 65 mmHg or relative thresholds of 20% were progressively related to both myocardial and kidney injury. At any given threshold, prolonged exposure was associated with increased odds. There were no clinically important interactions between preoperative blood pressures and the relationship between hypotension and myocardial or kidney injury at intraoperative mean arterial blood pressures less than 65 mmHg. Absolute and relative thresholds had comparable ability to discriminate patients with myocardial or kidney injury from those without.The associations based on relative thresholds were no stronger than those based on absolute thresholds. Furthermore, there was no clinically important interaction with preoperative pressure. Anesthetic management can thus be based on intraoperative pressures without regard to preoperative pressure.
科研通智能强力驱动
Strongly Powered by AbleSci AI