文章摘要
胰十二指肠切除术中难治性低血压的危险因素
Risk factors for the refractory intraoperative hypotension in patients with open pancreaticoduodenectomy
  
DOI:10.12089/jca.2020.12.008
中文关键词: 胰十二指肠切除术  围术期低血压  危险因素
英文关键词: Pancreaticoduodenectomy  Intraoperative hypotension  Risk factors
基金项目:国家自然科学基金(81801061)
作者单位E-mail
李娜娜 210029,南京医科大学第一附属医院麻醉与围术期医学科  
孙兆楚 210029,南京医科大学第一附属医院麻醉与围术期医学科  
任晶晶 210029,南京医科大学第一附属医院麻醉与围术期医学科  
马蓉 210029,南京医科大学第一附属医院麻醉与围术期医学科  
钱燕宁 210029,南京医科大学第一附属医院麻醉与围术期医学科  
胡有力 210029,南京医科大学第一附属医院麻醉与围术期医学科 huyouli@hotmail.com 
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中文摘要:
      
目的 分析和探讨胰十二指肠切除术患者术中发生难治性低血压的危险因素。
方法 本研究为回顾性病例-对照研究,收集2018年1月至2019年12月接受胰十二指肠切除手术患者649例的临床资料,男382例,女267例,年龄18~90岁,ASA Ⅰ—Ⅳ级。难治性低血压定义为术中SBP<90 mmHg或SBP降低幅度超过基础值的20%,且经过相应升血压处理,低血压累计时间超过30 min,或术中需要血管活性药持续泵注。根据术中是否发生难治性低血压将患者分为两组:低血压组和非低血压组。收集并整理患者术前和术中相关临床指标,分别行单因素和多因素分析术中发生难治性低血压的危险因素。
结果 有276例(42.53%)患者发生术中难治性低血压。与非低血压组比较,低血压组患者年龄明显增大,ASA分级明显增加,高血压比例明显升高,术前白蛋白浓度明显降低,手术时间明显延长,总入量、总入超量、出血量明显增多,乳酸(Lac)浓度明显升高,血糖均值(Glumean)和血糖变异系数(GluCV)明显升高(P<0.05)。多因素Logistic回归分析显示,ASA分级增加(每增加一级OR=1.748,95%CI 1.163~2.628)、高血压病史(OR=1.555,95%CI 1.071~2.256)、GluCV(每增加1OR=1.106,95%CI 1.080~1.133)和出血量增加(每增加500 ml,OR=2.050,95%CI 1.482~2.836)是术中难治性低血压的独立危险因素。
结论 ASA分级增加、高血压病史、血糖变异系数和出血量增加是胰十二指肠切除术中发生难治性低血压的独立危险因素。
英文摘要:
      
Objective To investigate the risk factors for the refractory intraoperative hypotension during open pancreaticoduodenectomy.
Methods A total of 649 patients undergoing open pancreaticoduodenectomy between January 2018 and December 2019, 382 males and 267 females, ASA physical status Ⅰ-Ⅳ, were included in this case-control study. The refractory hypotension was defined: (1) the intraoperative systolic blood pressure was either below 90 mmHg, or dropped more than 20% of the base value, the cumlative time was more than 30 minutes during and after treatment with vasoconstrictor and fluid therapy; (2) continuous infusion of norepinephrine or phenylephrine was required. Patients were divided into the hypotension group and the non-hypotension group according to the blood pressure alteration during the operation. The clinical features were collected and the relevant risk factors were analyzed using univariate analysis and multivariate Logistic regression analysis.
Results Among 649 patients enrolled in the study, there were 276 (42.53%) patients with refractory hypotension during pancreaticoduodenectomy. Univariate analysis indicated that there were statistically significant differences in age, ASA classification, history of hypertension, preoperative albumin level, operation time, total input, total intake excess, blood loss, intraoperative hemoglobin, lactic acid, blood glucose, and coefficient of variation of blood glucose (GluCV) between the two groups (P < 0.05). The independent risk factors of refractory hypotension were ASA classification (OR = 1.748, 95% CI 1.163-2.628), hypertension (OR = 1.555, 95% CI 1.071-2.256), GluCV (OR = 1.106,95% CI 1.08-1.133), and the volume of blood loss (OR = 2.050, 95% CI 1.482-2.836).
Conclusion High ASA classification, history of hypertension, GluCV, and the increase of the volume of blood loss are independent risk factors for refractory hypotension during pancreatoduodenectomy.
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