文章摘要
非心脏手术患者术中血压变异性与术后心肌损伤的相关性
Correlation of intraoperative blood pressure variability on postoperative myocardial injury in patients undergoing non-cardiac surgery
  
DOI：10.12089/jca.2026.03.003
中文关键词: 术后心肌损伤  血压变异性  术后并发症  非心脏手术
英文关键词: Postoperative myocardial injury  Blood pressure variability  Postoperative complications  Non-cardiac surgery
基金项目:河北省医学科学研究课题计划（20221575）
作者单位E-mail
岳静 075000,张家口市,河北北方学院研究生学院  
蔡立松 华北理工大学附属开滦总医院麻醉科 420444788@qq.com 
刘雨佳 华北理工大学附属开滦总医院麻醉科  
王博华 075000,张家口市,河北北方学院研究生学院  
于秋玲 075000,张家口市,河北北方学院研究生学院  
杜欣月 华北理工大学附属开滦总医院麻醉科  
韩庆波 华北理工大学附属开滦总医院麻醉科  
郝悦 华北理工大学附属开滦总医院麻醉科  
高朋 华北理工大学附属开滦总医院麻醉科  
王蕾 华北理工大学附属开滦总医院心内科  
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中文摘要:
      
目的： 探究非心脏手术患者术中血压变异性（IBPV）与术后心肌损伤（MINS）的相关性。
方法： 回顾性收集2016年10月至2024年9月接受全麻非心脏手术患者的病历资料。MINS诊断标准：术后30 d内任何测定中至少有一个心肌肌钙蛋白（cTn）值高于第99个百分位数参考上限且无非缺血性病因证据。提取术中SBP、DBP监测数据，计算MAP、脉压（PP），并采用标准差（SD）、变异系数（CV）、平均真实变异性（ARV）、独立于平均值的变异性（VIM）量化血压变异性。采用多因素Logistic回归分析术中血压变异性和MINS的相关性。绘制IBPV指标及其联合对MINS发生风险的受试者工作特征（ROC）曲线，计算曲线下面积（AUC）及95%可信区间（CI）。以其他术中血压参数变异性指标对MINS的影响作为敏感性分析。
结果： 共纳入患者1 226例，有176例（14.4%）发生MINS。多因素Logistic回归分析显示，术中SBPSD（OR=1.042，95%CI 1.021～1.063，P<0.001）、SBPCV（OR=1.162，95%CI 1.049～1.536，P=0.018）、MAPSD（OR=1.034，95%CI 1.014～1.057，P=0.010）、MAPARV （OR=1.048，95%CI 1.005～1.093，P=0.027）和PPCV （OR=1.051，95%CI 1.023～1.095，P=0.025）偏高均可增加MINS的风险。术中SBPSD预测MINS的AUC为0.704（95%CI 0.662～0.747），截断值为21.27，敏感性为0.662，特异性为0.803。SBPCV预测MINS的AUC为0.701（95%CI 0.658～0.743），截断值为0.16，敏感性为0.733，特异性为0.573。SBPARV预测MINS的AUC为0.693（95%CI 0.650～0.736），截断值为16.09，敏感性为0.722，特异性为0.582。SBPVIM预测MINS的AUC为0.693（95%CI 0.650～0.736），截断值为16.40，敏感性为0.705，特异性为0.604。多指标联合预测MINS的AUC为0.720（95%CI 0.677～0.762），截断值为0.15，敏感性为0.765，特异性为0.708。
结论： 非心脏手术患者术中SBP、MAP和PP变异性增加会使MINS的风险升高，术中SBP变异性对MINS具有一定预测价值。
英文摘要:
      
Objective: To investigate the effect of intraoperative blood pressure variability (IBPV) on myocardial injury after non-cardiac surgery (MINS).
Methods: Medical records of adult patients who underwent non-cardiac surgery under general anesthesia from October 2016 to September 2024 were collected retrospectively. The diagnosis of MINS was diagnosed if at least one myocardial troponin (cTn) level was higher than the 99th percentile upper reference limit (URL) in any measurement within 30 days after surgery, with no evidence of non-ischemic causes. Intraoperative monitoring data of systolic blood pressure (SBP) and diastolic blood pressure (DBP) were extracted to calculate mean arterial pressure (MAP) and pulse pressure (PP). Standard deviation (SD), coefficient of variation (CV), average real variability (ARV), and variation independent of mean (VIM) were used to quantify blood pressure variability. Multivariate logistic regression was applied to analyze the relationship between intraoperative SBP variability and MINS. The receiver operating characteristic (ROC) curve of blood pressure variability index and its combination on the risk of MINS was drawn, the area under the curve (AUC) and 95% confidence interval (CI) were calculated.
Results: A total of 1 226 patients were included, 176 patients (14.4%) occurred MINS. Multivariate logistic regression analysis showed that increased SBPSD (OR = 1.042, 95% CI 1.021-1.063, P < 0.001), SBPCV (OR = 1.162, 95% CI 1.049-1.536, P = 0.018), MAPSD (OR = 1.034, 95% CI 1.014-1.057, P = 0.010), MAPARV (OR = 1.048, 95% CI 1.005-1.093, P = 0.027) and PPCV (OR = 1.051,95% CI 1.023-1.095, P = 0.025) were both associated with an increased risk of MINS. The AUC of intraoperative SBPSD in predicting MINS was 0.704 (95% CI 0.662-0.747), the cutoff value was 21.27, the sensitivity was 0.662, and the specificity was 0.803. The AUC of SBPCV in predicting MINS was 0.701 (95% CI 0.658-0.743), the cutoff value was 0.16, the sensitivity was 0.733, and the specificity was 0.573. The AUC of SBPARV in predicting MINS was 0.693 (95% CI 0.650-0.736), the cutoff value was 16.09, the sensitivity was 0.722, and the specificity was 0.582. The AUC of SBPVIM in predicting MINS was 0.693 (95% CI 0.650-0.736), the cutoff value was 16.40, the sensitivity was 0.705, and the specificity was 0.604. The AUC of multi-index combined prediction of MINS was 0.720 (95% CI 0.677-0.762), the cutoff value was 0.15, the sensitivity was 0.765, and the specificity was 0.708.
Conclusion: Increased intraoperative SBP, MAP, and PP variability elevates the risk of myocardial injury after non-cardiac surgery, and intraoperative SBP variability has a certain predictive value for myocardial injury after non-cardiac surgery.
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