Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury.
Prevalence and risk factors for intraoperative hypotension during craniotomy for traumatic brain injury.
复制标题
创伤性脑损伤开颅手术期间术中低血压的患病率和危险因素。
DOI：
10.1097/ana.0b013e318254fb70
复制
发表时间：
2012
影响因子：
3.7
通讯作者：
Vavilala,MonicaS
中科院分区：
文献类型：
--
作者：
Sharma,Deepak;Brown,MichelleJ;Curry,Parichat;Noda,Sakura;Chesnut,RandallM;Vavilala,MonicaS
背景：创伤性脑损伤（TBI）后低血压与预后不良相关。然而，关于术中低血压（IH）的数据很少，麻醉剂对IH的影响尚不清楚。我们研究了IH的患病率和危险因素，包括麻醉剂在紧急开颅手术孤立TBI.Methods的效果：这是一个回顾性队列研究的患者18岁及以上，谁接受了紧急开颅手术TBI在港景医疗中心（1级创伤中心）2007年10月至2010年1月。从医疗和电子麻醉记录中提取人口统计学、临床和影像学特征以及血流动力学和麻醉数据。低血压定义为收缩压< 90 mm Hg。采用单因素分析比较IH患者与非IH患者的临床特征，采用多因素Logistic回归分析确定IH的独立危险因素。IH常见（n= 73，65%），但不受麻醉剂选择的影响。IH的独立风险因素为多发性计算机断层扫描（CT）病变[校正比值比（AOR）19.1; 95%置信区间（CI），2.08-175.99; P= 0.009]，硬膜下血肿（AOR 17.9; 95% CI，2.97-108.10; P= 0.002），最大CT病变厚度（AOR 1.1; 95%CI，1.01-1.13; P= 0.016）和麻醉持续时间（AOR 1.1; 95%CI，1.01-1.30; P= 0.009）。多发CT病灶、硬膜下血肿、CT病灶最大厚度和麻醉持续时间较长增加了IH的风险。
Background:Hypotension after traumatic brain injury (TBI) is associated with poor outcomes. However, data on intraoperative hypotension (IH) are scarce and the effect of anesthetic agents on IH is unknown. We examined the prevalence and risk factors for IH, including the effect of anesthetic agents during emergent craniotomy for isolated TBI.Methods:This is a retrospective cohort study of patients 18 years and above, who underwent emergent craniotomy for TBI at Harborview Medical Center (level 1 trauma center) between October 2007 and January 2010. Demographic, clinical, and radiographic characteristics and hemodynamic and anesthetic data were abstracted from medical and electronic anesthesia records. Hypotension was defined as systolic blood pressure< 90 mm Hg. Univariate analyses were performed to compare the clinical characteristics of patients with and without IH, and multiple logistic regression analysis was used to determine independent risk factors for IH.Results:Data abstracted from 113 eligible patients aged 48±19 years were analyzed. IH was common (n= 73, 65%) but not affected by the choice of anesthetic agent. Independent risk factors for IH were multiple computed tomographic (CT) lesions [adjusted odds ratios (AOR) 19.1; 95% confidence interval (CI), 2.08-175.99; P= 0.009], subdural hematoma (AOR 17.9; 95% CI, 2.97-108.10; P= 0.002), maximum CT lesion thickness (AOR 1.1; 95% CI, 1.01-1.13; P= 0.016), and anesthesia duration (AOR 1.1; 95% CI, 1.01-1.30; P= 0.009).Conclusions:IH was common in adult patients with isolated TBI undergoing emergent craniotomy. The presence of multiple CT lesions, subdural hematoma, maximum thickness of CT lesion, and longer duration of anesthesia increase the risk for IH.