Carbon Dioxide, Blood Pressure, and Perioperative Stroke: A Retrospective Case-Control Study.
Carbon Dioxide, Blood Pressure, and Perioperative Stroke: A Retrospective Case-Control Study.
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DOI：
10.1097/aln.0000000000004354
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发表时间：
2022-10-01
期刊：
影响因子：
8.8
通讯作者：
中科院分区：
文献类型：
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作者：
术中生理学和术后卒中之间的关系尚未完全了解。初步数据表明，低碳酸血症或高碳酸血症伴随脑血管流入减少（例如，由于低血压）可导致局部缺血。本研究验证了术中低血压和低碳酸血症或高碳酸血症与术后缺血性卒中相关的假设。我们通过多中心围手术期结局组进行了一项回顾性病例对照研究。从2004年1月至2015年12月期间的五个主要学术中心提取非心脏、非颅内和非重大血管手术病例（年龄≥18岁）。缺血性卒中病例通过手动病历审查确定，并与对照组匹配（1：4）。根据曲线下总面积计算低于关键平均动脉血压阈值（<55 mmHg、<60 mmHg、<65 mmHg）和超出特定呼气末二氧化碳阈值（≤30 mmHg、≤35 mmHg、≥45 mmHg）的时间和降低。然后检验中风和总曲线下面积值之间的相关性，同时调整相关混杂因素。总共分析了1，244，881例病例。在筛选为中风阳性的病例（n= 1，702）中，126例得到确认，并与500例相应的对照成功匹配。对于所有测试的阈值，曲线下总面积与卒中显著相关，在MAP <55 mmHg时观察到最强的组合（每10 mmHg-min校正的比值比，1.17 [95%置信区间，1.10 - 1.23]，p<0.0001）和潮气末二氧化碳≥45 mmHg（每10 mmHg-min的校正比值比，1.11 [95%置信区间，1.10 - 1.11]，p<0.0001）。血压和二氧化碳之间没有观察到相互作用。术中低血压和二氧化碳失调可能各自独立地增加术后卒中风险。
The relationship between intraoperative physiology and postoperative stroke is incompletely understood. Preliminary data suggest that either hypo- or hypercapnia coupled with reduced cerebrovascular inflow (e.g., due to hypotension) can lead to ischemia. This study tested the hypothesis that the combination of intraoperative hypotension and either hypo- or hypercarbia is associated with postoperative ischemic stroke. We conducted a retrospective, case-control study via the Multicenter Perioperative Outcomes Group. Non-cardiac, non-intracranial, and non-major vascular surgical cases (age ≥18 years) were extracted from five major academic centers between January 2004 and December 2015. Ischemic stroke cases were identified via manual chart review and matched to controls (1:4). Time and reduction below key mean arterial blood pressure thresholds (<55 mmHg, <60 mmHg, <65 mmHg) and outside of specific end-tidal carbon dioxide thresholds (≤30 mmHg, ≤35 mmHg, ≥45 mmHg) were calculated based on total area under the curve. The association between stroke and total area under the curve values was then tested while adjusting for relevant confounders. In total, 1,244,881 cases were analyzed. Among the cases that screened positive for stroke (n=1,702), 126 were confirmed and successfully matched with 500 corresponding controls. Total area under the curve was significantly associated with stroke for all thresholds tested, with the strongest combination observed with MAP <55 mmHg (adjusted odds ratio per 10 mmHg-min, 1.17 [95% confidence interval, 1.10 – 1.23], p<0.0001) and end-tidal carbon dioxide ≥45 mmHg (adjusted odds ratio per 10 mmHg-min, 1.11 [95% confidence interval, 1.10 – 1.11], p<0.0001). There was no interaction effect observed between blood pressure and carbon dioxide. Intraoperative hypotension and carbon dioxide dysregulation may each independently increase postoperative stroke risk.
影响因子：
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作者：
Keshavarzi S;Ayatollahi SM;Zare N;Pakfetrat M
通讯作者：
Pakfetrat M