Intraoperative Systolic Blood Pressure Variability Predicts 30-day Mortality in Aortocoronary Bypass Surgery Patients
Intraoperative Systolic Blood Pressure Variability Predicts 30-day Mortality in Aortocoronary Bypass Surgery Patients
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DOI：
10.1097/aln.0b013e3181e07ee9
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发表时间：
2010-08-01
期刊：
影响因子：
8.8
通讯作者：
Newman, Mark
中科院分区：
文献类型：
--
作者：
Aronson, Solomon;Stafford-Smith, Mark;Newman, Mark
背景：在心脏手术中，很少有数据支持血压变异性与临床结果之间的联系。我们验证术中血压变异性超出目标血压范围可以预测心脏手术患者30天死亡率的假设。方法：从1996年9月1日至2005年12月31日连续7,504例冠状动脉旁路手术中获得的电子采集的血压数据分为开发和验证队列。血压范围以外的收缩压变异性发作(例如，高于135或低于95毫米汞柱)以发作次数、发作幅度、发作持续时间和偏离幅度x持续时间(即曲线下面积)为特征。采用多因素Logistic回归分析评估30天死亡率的相关性。在验证队列中检验最具预测性的死亡风险特征和血压范围。结果：总共分析了310万例术中血压评估。在5038名患者中计算了收缩压变异性，并在2466名患者中进行了验证(8%的患者没有体外循环，6%的患者接受了瓣膜手术)。在所有检测血压变异性的指标中，平均收缩期漂移持续时间(105-130毫米汞柱以外)对30天死亡率的预测作用最大(优势比=1.03/分钟，95%可信区间为1.02-1.39，P<；0.0001)。结论：术中血压变异性与行主动脉冠状动脉搭桥术的患者术后30天死亡率有关。
Background: Few data support an association between blood pressure variability and clinical outcomes during cardiac surgery. We tested the hypothesis that intraoperative systolic blood pressure variability outside a targeted blood pressure range predicts 30-day mortality in patients undergoing cardiac surgery.Methods: Electronically captured blood pressure data from 7,504 consecutive coronary bypass surgery procedures between September 1, 1996, and December 31, 2005, were divided into development and validation cohorts. Systolic blood pressure variability episodes outside a blood pressure range (e. g., higher than 135 or lower than 95 mmHg) were characterized by number of episodes, magnitude of episode, duration of episode, and magnitude x duration of excursion (i.e., area under the curve). Multiple logistic regression analysis was used to assess 30-day mortality association. The most predictive mortality risk characteristic and blood pressure range was tested in the validation cohort.Results: A total of 3.1 million intraoperative blood pressure evaluations were analyzed. Systolic blood pressure variability was derived in 5,038 patients and validated in 2,466 patients (8% without cardiopulmonary bypass and 6% with valve procedure). Among all tested indices of blood pressure variability, mean duration of systolic excursion (outside a range of 105-130 mmHg) was most predictive of 30-day mortality (odds ratio = 1.03 per minute, 95% CI 1.02-1.39, P < 0.0001).Conclusions: Intraoperative blood pressure variability is associated with 30-day postoperative mortality in patients undergoing aortocoronary bypass surgery.