胸腔镜下单侧肺部分切除术中低血压的相关因素分析

Relative risk factors for intraoperative hypotension in patients undergoing thoracoscopic unilateral pulmonary resection

目的探讨胸腔镜下单侧肺部分切除术患者发生术中低血压(IOH)的相关因素。方法回顾性分析2018年3月至2019年3月择期行胸腔镜下单侧肺部分切除术的1731例患者临床资料,收集相关临床指标,通过单因素及多因素分析各临床指标与IOH的相关性。IOH定义为SBP下降幅度超过基础值的30%持续时间超过5 min,或术中采用间断推注或静脉泵注血管活性药物。结果396例(22.88%)术中出现IOH。单因素分析显示,年龄、性别、ASA分级、有无高血压病史、有无糖尿病病史、手术方式、手术时间以及术中液体输注速率与IOH的发生有关(P<0.05)。Logistic回归分析显示,年龄≥60岁(OR=2.701,95%CI 1.467~4.976)、高血压病史(SBP≥140/90 mmHg,OR=1.858,95%CI 1.441~2.396)、肺叶切除术(OR=1.465,95%CI 1.033~2.077)为IOH的独立危险因素。结论胸腔镜下行单侧肺部分切除术的患者,应根据其年龄、高血压病史、手术方式、术中液体输注速率,评估IOH发生风险,并采取合理方式维持血流动力学的稳定。

Objective To explore the related risk factors for intraoperative hypotension(IOH)in patients undergoing thoracoscopic unilateral pneumoresection.Methods A total of 1731 elective general surgery patients undergoing thoracoscopic pulmonary resection during the period of March 2018 to March 2019 were enrolled and their clinical data were collected to analyze the relativity of IOH by univariate analysis and multivariate Logistic regression analysis retrospectively.The definition of IOH is systolic blood pressure decrease≥30%from baseline for≥5 minutes or repeated administration of vasopressor during operation.Results Among the 1731 patients enrolled in this study,there were 396(22.88%)patients who developed IOH.The univariate analysis showed that age,gender,ASA physical status,the history of hypertension,the history of diabetes mellitus,the type of surgery,the duration of operation and the rate of infusion of intraoperative fluids had significant relations with IOH(P<0.05).Multivariate Logistic regression showed that age≥60 years(OR=2.701,95%CI 1.467-4.976),the history of hypertension(stable blood pressure≥140/190 mmHg,OR=1.858,95%CI 1.441-2.396),pulmonary lobectomy(OR=1.465,95%CI 1.033-2.077)were independent variables significantly related to IOH.Conclusion The evaluation of the risk of IOH should according to age,the history of hypertension,pulmonary lobectomy to evaluate the avoidance of IOH episodes during the circulation management,and responsible ways should be taken to make the hemodynamics stable when patients undergoing thoracoscopic unilateral pneumoresection.