原发性高血压病人行全膝关节置换术围术期血压达标的影响因素分析

Analysis of Factors Influencing Perioperative Uncontrolled Blood Pressure in Primary Hypertensive Patients Undergoing Total Knee Arthroplasty

目的探讨原发性高血压病人行全膝关节置换术(total knee arthroplasty,TKA)围术期血压达标的影响因素。方法回顾性分析我院运动医学研究所2016年1～10月257例原发性高血压行TKA的临床资料,入选169例,分为血压不达标组(n=91)和血压达标组(n=78),先进行单因素分析,有统计学差异的变量通过多因素logistic回归评价与围术期血压达标的相关性。结果单因素分析显示有统计学差异的因素包括入院收缩压、入院脉压差、围术期镇痛、术后24 h内最大疼痛数字评分(Numerical Rating Scale,NRS),P值分别为0.000、0.001、0.000、0.002。多因素logistic分析结果显示,股神经阻滞为围术期血压不达标的保护性因素(OR=0.049,P=0.000),入院收缩压升高为围术期血压不达标的独立预后因素(OR=14. 491,P=0.000)。结论股神经阻滞镇痛有利于原发性高血压病人行TKA围术期血压达标,入院收缩压和脉压差升高不利于围术期血压达标,且入院收缩压≥140 mm Hg、入院脉压差≥60 mm Hg增加围术期血压不达标的风险。

Objective To explore the influencing factors of uncontrolled blood pressure during perioperative period in patients with primary hypertension undergoing total knee arthroplasty(TKA).Methods A retrospective analysis was made on 169 patients with primary hypertension admitted to our hospital from January 2016 to October 2016 for TKA treatment.They were divided into two groups:the uncontrolled blood pressure group(n=91)and the controlled blood pressure group(n=78).The clinical data of the two groups were collected.The differences of factors between the two groups were compared by univariate analysis.The factors with significant differences were evaluated by multivariate logistic regression.Results Univariate analysis showed that factors with statistical differences included admission systolic blood pressure,admission pulse pressure difference,maximum pain evaluated by Numerical Rating Scale(NRS)scores within 24 h after surgery,and peri-operative analgesia(P=0.000,0.001,0.000,0.002,respectively).Multivariate logistic analysis showed that femoral nerve block was protective factors for uncontrolled blood pressure during perioperative period(OR=0.049,P=0.000),and higher admission systolic blood pressure was an independent prognostic factor for uncontrolled blood pressure during perioperative period(OR=14.491,P=0.000).Conclusions The use of femoral nerve block is a protective factor for uncontrolled blood pressure in patients with TKA during perioperative period.Increased systolic blood pressure and pulse pressure difference at admission are adverse to uncontrolled blood pressure in patients with TKA.Admission systolic blood pressure above 140 mm Hg and pulse pressure difference above 60 mm Hg could increase the risk of uncontrolled blood pressure in patients with TKA during perioperative period.