动态血压指标对老年高血压患者蛛网膜下腔阻滞后低血压的预测价值  

Predictive value of ambulatory blood pressure indicators for hypotension after subarachnoid block in elderly hypertensive patients

作　　者：吴维强[1] 姚泽宇[1] 王学军[1] Wu Weiqiang;Yao Zeyu;Wang Xuejun(Department of Anesthesiology,Qinghai Red Cross Hospital,Qinghai Xining 810000,China)

机构地区：[1]青海红十字医院麻醉科,青海西宁810000

出　　处：《中国医刊》2023年第7期751-755,共5页Chinese Journal of Medicine

基　　金：青海省卫生健康委员会项目(2021-wjzd-19)。

摘　　要：目的 探讨动态血压指标对老年高血压患者蛛网膜下腔阻滞后低血压的预测价值。方法 选取2020年6月至2021年12月青海红十字医院收治的119例于蛛网膜下腔阻滞下接受骨科手术的老年(年龄≥60岁)高血压患者为研究对象,根据蛛网膜下腔阻滞后是否发生低血压将研究对象分为血压正常组(85例)和低血压组(34例),比较分析两组患者的临床特征和动态血压指标。分析老年高血压患者蛛网膜下腔阻滞后发生低血压的独立影响因素以及非杓型血压对老年高血压患者蛛网膜下腔阻滞后发生低血压的预测价值。结果 低血压组患者的年龄、美国麻醉医师协会(American Society of Anesthesiologists,ASA)分级为Ⅱ级的比例、使用β受体阻滞剂的比例以及非杓型血压的比例均显著大于或高于血压正常组(P<0.05)。多因素logistic回归分析结果显示,使用β受体阻滞剂、非杓型血压是老年高血压患者蛛网膜下腔阻滞后发生低血压的独立危险因素(P<0.05)。受试者工作特征曲线分析结果显示,年龄、ASA分级为Ⅱ级、使用β受体阻滞剂三联指标预测老年高血压患者蛛网膜下腔阻滞后发生低血压的曲线下面积为0.64,敏感度为76.2%,特异度为56.9%。年龄、ASA分级为Ⅱ级、使用β受体阻滞剂、非杓型血压四联指标预测老年高血压患者蛛网膜下腔阻滞后发生低血压的曲线下面积为0.81,敏感度为90.6%,特异度为64.7%。四联指标预测模型的效能显著高于三联指标(χ^(2)=16.254,P<0.001)。结论 非杓型血压是老年高血压患者蛛网膜下腔阻滞后发生低血压的独立危险因素,且加入非杓型血压指标的预测模型对老年高血压患者蛛网膜下腔阻滞后发生低血压的预测效能显著升高。Objective To explore the predictive value of ambulatory blood pressure indicators for hypotension after subarachnoid block in elderly hypertensive patients.Method 119 elderly patients(aged≥60 years)with hypertension who underwent orthopedic surgery under subarachnoid block admitted to Qinghai Red Cross Hospital from June 2020 to December 2021 were selected as subjects.According to whether hypotension occurred after subarachnoid block,subjects were divided into normal blood pressure group(85 cases)and hypotension group(34 cases).The clinical characteristics and ambulatory blood pressure indexes of the two groups were compared and analyzed.To analyze the independent influencing factors of hypotension after subarachnoid block in elderly patients with hypertension and the predictive value of non-arytenoid blood pressure in elderly patients with hypertension after subarachnoid block.Result The age,proportion of ASA gradeⅡ,proportion ofβ-blocker,and proportion of non-arytenoid blood pressure in the hypotension group were significantly higher than those in the normal blood pressure group(P<0.05).Multivariate logistic regression analysis showed thatβ-blocker and non-dipper blood pressure were independent factors for hypotension after subarachnoid block in elderly patients with hypertension(P<0.05).ROC curve analysis results showed that the area under the curve of age,ASA gradeⅡandβ-blocker three-index predicting hypotension after subarachnoid block in elderly patients with hypertension was 0.64,with the sensitivity of 76.2%,and the specificity of 56.9%.The area under the curve of age,ASA gradeⅡ,β-blocker,and non-dipper blood pressure four-index predicting hypotension after subarachnoid block in elderly patients with hypertension was 0.81,with the sensitivity of 90.6%,and the specificity of 64.7%.The prediction efficiency of the four-index model was significantly higher than that of the three-index model(χ^(2)=16.254,P<0.001).Conclusion Non-dipper blood pressure is an independent risk factor for hypotension a

关 键 词：动态血压 老年 蛛网膜下腔阻滞 非杓型血压 低血压 

分 类 号：R614[医药卫生—麻醉学]