老年非心脏手术麻醉诱导中低血压的影响因素及风险预测模型的构建  

Characteristics and influencing factors of intraoperative hypotension during anesthesia in elderly non-cardiac surgery patients and risk prediction model

作　　者：尹华江 孙兴祥 郦萍 YIN Huajiang;SUN Xingxiang;LI Ping(Shaoxing Kegiao District Hospital of Traditional Chinese Medicine,Shaoxing 312030,China)

机构地区：[1]绍兴市柯桥区中医医院,浙江绍兴312030

出　　处：《浙江实用医学》2022年第6期469-472,共4页Zhejiang Practical Medicine

摘　　要：目的 探讨影响老年非心脏手术麻醉诱导中低血压(PIH)的相关影响因素,以此构建预测模型并进行验证。方法 回顾性选取2019年1月-2021年1月于浙江省绍兴市柯桥区中医医院行全身麻醉的非心脏手术的老年患者214例,收集患者的相关资料。根据患者是否发生麻醉诱导后低血压将患者分为低血压组(72例)与非低血压组(142例),采用单因素及多因素Logistic回归分析影响患者发生PIH的独立影响因素。结果 年龄、合并高血压、麻醉诱导到手术时间、ALB、ASA分级、诱导的阿片类药物、使用咪达唑仑、诱导的静脉麻醉药均为影响患者发生PIH的独立影响因素(P<0.05);以此构建的风险模型预测效能良好。结论 对老年患者麻醉前尽可能做到充分评估,合理使用诱导药物,并可适当使用血管活性药物或加速输液等预防措施,这些措施可能帮助老年患者降低PIH发生率,提高麻醉安全性。Objective To explore the relevant influencing factors of post-induction hypotension(PIH)in elderly non-cardiac surgery patients under general anesthesia and to construct a prediction model for risk assessment.Methods A retrospective analysis was conducted on 214 elderly patients who underwent non-cardiac surgery under general anesthesia at Shaoxing Kegiao District Hospital of Traditional Chinese Medicine from January 2019 to January 2021.The patient data were collected and analyzed,and the patients were divided into the hypotension group(72 cases)and the non-hypotension group(142 cases)based on whether they had PIH.Logistic regression analysis was used to analyze the independent influencing factors of PIH.Results The results of the univariate analysis showed that there were significant differences in age,hypertension,diabetes,fasting time,emergency surgery,induction-to-surgery time,albumin(ALB),American Society of Anesthesiologists(ASA)physical status classification,opioid induced during induction,use of midazolam,and intravenous anesthetic indicators between the two groups(P<0.05).The results of multivariate analysis showed that age,hypertension,induction-to-surgery time,ALB,ASA classification,opioid induced during induction,use of midazolam,and intravenous anesthetic were independent influencing factors for PIH(P<0.05).Conclusion For elderly patients,it is necessary to fully evaluate before anesthesia,use induction drugs reasonably,and take preventive measures such as using vasodilators or accelerating infusion appropriately.These measures may help reduce the incidence of perioperative hypertension and improve the safety of anesthesia for elderly patients.

关 键 词：老年人 全身麻醉 麻醉诱导后低血压 危险因素 预测模型 

分 类 号：R614[医药卫生—麻醉学]