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小儿腹股沟疝修补术全麻诱导后低收缩压及相关患者和围手术期因素的回顾性观察研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周菁 编辑：杨荣峰 审校：曹莹
婴儿在麻醉期间因低血压而面临脑灌注不足的风险。作者进行了一项回顾性观察研究，以确定与健康婴儿低收缩压（SBP）相关的患者和围手术期因素。
作者获得了 2015 年 1 月至 2019 年 3 月期间接受腹股沟疝修补术的 266 名 0-6 个月婴儿的围手术期数据。在两个阶段对 SBP 进行分析：准备阶段（手术开始前 20 分钟直至切皮）和手术阶段（手术开始后 15 至 35 分钟）。低 SBP 被定义为低于特定阶段和体重参考值第 50 个百分位数两个标准差的值。
在准备和手术阶段，分别在 11% （29/265） 和 5% （13/259） 的患者中观察到低 SBP。在两个阶段，肌松药的使用都与正常 SBP 相关 （回归系数 β = 6.15 和 p = 0.002，回归系数 β = 6.52 和 p < 0.001）。SBP 与体重的相关性比与年龄的相关性比更强 （两个阶段调整后的标准化回归系数的比率 = 2.0）。在控制协变量后，接受肌松药的患者在准备阶段的低 SBP 测量值显著减少 （回归系数 β = -1.99 和 p < 0.001）。
在患者因素方面，在全身麻醉下的健康婴儿中，体重与 SBP 的相关性比年龄更强。麻醉诱导期间使用肌松药与准备阶段较低的低 SBP 测量值相关。
原始文献来源：Nelson,O. , Wu,L. , Berger,J.A. , Yuan,I. , Padiyath,A. , Stricker,P.A. , Tsui,F.R. ,& Simpao , A.F.(2024).A Retrospective Observational Study of Post-Induction Low Systolic Blood Pressure and Associated Patient and Perioperative Factors in Infants Undergoing General Anesthesia for Inguinal Hernia Repair.1(2),80-90.https://doi.org/10.3390/anesthres1020009
A Retrospective Observational Study of Post-Induction Low Systolic Blood Pressure and Associated Patient and Perioperative Factors in Infants Undergoing General Anesthesia for Inguinal Hernia RepairAbstract
Background: Infants are at risk of cerebral hypoperfusion from low blood pressure during anesthesia. We conducted a retrospective observational study to determine the patient and perioperative factors associated with low systolic blood pressure (SBP) in healthy infants.
Method:We obtained perioperative data of 266 infants aged 0–6 months who underwent inguinal hernia repair between January 2015 and March 2019 at our institution. SBP was analyzed during two phases:the preparation phase (20 min before procedure start until incision) and the surgical phase (15 to 35 min after procedure start). Low SBP was defined as a value lower than two standard deviations below the 50th percentile for a phase- and weight-specific reference value.
Results:Low SBP was observed in 11% (29/265) and 5% (13/259) of patients during the preparation and surgical phases,respectively. Neuromuscular blockade use was associated with normal SBP in both phases (regression coefficient β = 6.15 and p = 0.002, regression coefficient β = 6.52 and p < 0.001, respectively). SBP was more strongly associated with weight than with age (ratio of adjusted standardized regression coefficient = 2.0 in both phases). After controlling for covariates, patients given neuromuscular blockade had significantly fewer low SBP measurements during the preparation phase (regression coefficient β = −1.99 and p < 0.001).
Conclusion：With respect to patient factors, in healthy infants under general anesthesia, weight was more strongly associated with SBP than age. A neuromuscular blocking agent administered during anesthesia induction was associated with fewer low SBP measurements in the preparation phase.
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