老年人围手术期血压变化

doi:10.3877/cma.j.issn.1674-0785.2022.03.016

随着人口老龄化，老年高血压患者的患病率逐年增加，需选择外科手术的老年高血压患者也逐渐增多。由于围手术期发生的生理性变化，血流动力学不稳定在围手术期很常见。尽管存在这种血流动力学改变频率及与其相关的潜在危害，特别是在老年人群中，但缺乏优化围手术期血压的指南。低血压与围手术期的不良结果有关，特别是肾损伤、心肌损伤和死亡率增加。个性化血压可能是老年人围手术期血压管理的关键。

关键词: 老年低血压, 血流动力学不稳定, 个性化血压管理

With the aging of the population, the prevalence rate of elderly patients with hypertension is increasing year by year and the number of elderly patients with hypertension who need surgery is also increasing gradually. Hemodynamic instability is common during the perioperative period because of the physiological changes that occur during such period. Despite the frequency of this hemodynamic change and the potential harm associated with it, especially in the elderly population, guidelines for optimizing perioperative blood pressure are lacking. Hypotension is associated with adverse perioperative outcomes, particularly kidney injury, myocardial injury, and increased mortality. Personalized management may be the key to perioperative blood pressure control in elderly patients.

Key words: Senile hypotension, Hemodynamic instability, Personalized blood pressure management

32	Sun LY, Chung AM, Farkouh ME, et al. Defining an intraoperative hypotension threshold in association with stroke in cardiac surgery [J]. Anesthesiology, 2018, 129(3): 440-447.
33	Phelan D, Watson C, Martos R, et al. Modest elevation in BNP in asymptomatic hypertensive patients reflects sub-clinical cardiac remodeling, inflammation and extracellular matrix changes [J]. PLoS One, 2012, 7(11): e49259.
34	McEvoy MD, Gupta R, Koepke EJ, et al. Perioperative quality initiative consensus statement on postoperative blood pressure, risk and outcomes for elective surgery [J]. Br J Anaesth, 2019, 122(5): 575-586.
35	Li G, Warner M, Lang BH, et al. Epidemiology of anesthesia-related mortality in the United States, 1999-2005 [J]. Anesthesiology, 2009, 110(4): 759-765.
36	Pearse RM, Moreno RP, Bauer P, et al. Mortality after surgery in Europe: a 7 day cohort study [J]. Lancet, 2012, 380(9847): 1059-1065.
37	Mascha EJ, Yang D, Weiss S, et al. Intraoperative mean arterial pressure variability and 30-day mortality in patients having noncardiac surgery [J]. Anesthesiology, 2015, 123(1): 79-91.
38	朱维铭, 许奕晗, 黎介寿. 围手术期处理进展——ERAS、围手术期外科之家与围手术期医学 [J]. 中国实用外科杂志, 2019, 39(2): 118-121.
39	Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients [J]. Chest, 1988, 94(6): 1176-1186.
40	Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients [J]. Crit Care Med, 2000, 28(10): 3396-3404.
41	Pearse R, Dawson D, Fawcett J, et al. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [J]. Crit Care, 2005, 9(6): R687-R693.
42	Sinclair S, James S, Singer M. Intraoperative intravascular volume optimisation and length of hospital stay after repair of proximal femoral fracture: randomised controlled trial [J]. BMJ, 1997, 315(7113): 909-912.
43	Godet T, Grobost R, Futier E. Personalization of arterial pressure in the perioperative period [J]. Curr Opin Crit Care, 2018, 24(6): 554-559.
44	Futier E, Lefrant JY, Guinot PG, et al. Effect of individualized vs standard blood pressure management strategies on postoperative organ dysfunction among high-risk patients undergoing major surgery: a randomized clinical trial [J]. JAMA, 2017, 318(14): 1346-1357.
45	Godet T, Grobost R, Futier E. Personalization of arterial pressure in the perioperative period [J]. Curr Opin Crit Care, 2018, 24(6): 554-559.
1	Hallqvist L, Granath F, Huldt E, et al. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery: An observational study [J]. Eur J Anaesthesiol, 2018, 35(4): 273-279.
2	Glance LG, Osler TM, Mukamel DB, et al. Effect of complications on mortality after coronary artery bypass grafting surgery: evidence from New York State [J]. J Thorac Cardiovasc Surg, 2007, 134(1): 53-58.
3	Williams B, Mancia G, Spiering W, et al. 2018 ESC/ESH Guidelines for the management of arterial hypertension: the Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology and the European Society of Hypertension [J]. J Hypertens, 2018, 36(10): 1953-2041.
4	Al-Qamari A, Adeleke I, Kretzer A, et al. Pulse pressure and perioperative stroke [J]. Curr Opin Anaesthesiol, 2019, 32(1): 57-63.
5	Packiasabapathy KS, Subramaniam B. Optimal perioperative blood pressure management [J]. Adv Anesth, 2018, 36(1): 67-79.
6	Whelton PK, Carey RM, Aronow WS, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on clinical practice guidelines [J]. J Am Coll Cardiol, 2018, 71(19): e127-e248.
7	Sanders RD, Hughes F, Shaw A, et al. Perioperative Quality Initiative consensus statement on preoperative blood pressure, risk and outcomes for elective surgery [J]. Br J Anaesth, 2019, 122(5): 552-562.
8	Ackland GL, Brudney CS, Cecconi M, et al. Perioperative Quality Initiative consensus statement on the physiology of arterial blood pressure control in perioperative medicine [J]. Br J Anaesth, 2019, 122(5): 542-551.
9	Vázquez-Narváez KG, Ulibarri-Vidales M. The patient with hypertension and new guidelines for therapy [J]. Curr Opin Anaesthesiol, 2019, 32(3): 421-426.
10	Kristensen SD, Knuuti J, Saraste A, et al. 2014 ESC/ESA Guidelines on non-cardiac surgery: cardiovascular assessment and management: the joint task force on non-cardiac surgery: cardiovascular assessment and management of the European Society of Cardiology (ESC) and the European Society of Anaesthesiology (ESA) [J]. Eur Heart J, 2014, 35(35): 2383-2431.
11	Fleisher LA, Fleischmann KE, Auerbach AD, et al. 2014 ACC/AHA guideline on perioperative cardiovascular evaluation and management of patients undergoing noncardiac surgery: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on practice guidelines [J]. Circulation, 2014, 130(24): 2215-2245.
12	Sessler DI, Meyhoff CS, Zimmerman NM, et al. Period-dependent Associations between hypotension during and for four days after noncardiac surgery and a composite of myocardial infarction and death: a substudy of the POISE-2 trial [J]. Anesthesiology, 2018, 128(2): 317-327.
13	Howell SJ. Preoperative hypertension [J]. Curr Anesthesiol Rep, 2018, 8(1): 25-31.
14	Venkatesan S, Myles PR, Manning HJ, et al. Cohort study of preoperative blood pressure and risk of 30-day mortality after elective non-cardiac surgery [J]. Br J Anaesth, 2017, 119(1): 65-77.
15	POISE Study Group, Devereaux PJ, Yang H, et al. Effects of extended-release metoprolol succinate in patients undergoing non-cardiac surgery (POISE trial): a randomised controlled trial [J]. Lancet, 2008, 371(9627): 1839-1847.
16	Bijker JB, van Klei WA, Vergouwe Y, et al. Intraoperative hypotension and 1-year mortality after noncardiac surgery [J]. Anesthesiology, 2009, 111(6): 1217-1226.
17	Hsieh JK, Dalton JE, Yang D, et al. The association between mild intraoperative hypotension and stroke in general surgery patients [J]. Anesth Analg, 2016, 123(4): 933-939.
18	Hirsch J, DePalma G, Tsai TT, et al. Impact of intraoperative hypotension and blood pressure fluctuations on early postoperative delirium after non-cardiac surgery [J]. Br J Anaesth, 2015, 115(3): 418-426.
19	Kertai MD, White WD, Gan TJ. Cumulative duration of "triple low" state of low blood pressure, low bispectral index, and low minimum alveolar concentration of volatile anesthesia is not associated with increased mortality [J]. Anesthesiology, 2014, 121(1): 18-28.
20	Babazade R, Yilmaz HO, Zimmerman NM, et al. Association between intraoperative low blood pressure and development of surgical site infection after colorectal surgery: a retrospective cohort study [J]. Ann Surg, 2016, 264(6): 1058-1064.
21	Pietropaoli JA, Rogers FB, Shackford SR,et al. The deleterious effects of intraoperative hypotension on outcome in patients with severe head injuries [J]. J Trauma, 1992, 33(3): 403-407.
22	Salmasi V, Maheshwari K, Yang D, et al. Relationship between intraoperative hypotension, defined by either reduction from baseline or absolute thresholds, and acute kidney and myocardial injury after noncardiac surgery: a retrospective cohort analysis [J]. Anesthesiology, 2017, 126(1): 47-65.
23	Tassoudis V, Vretzakis G, Petsiti A, et al. Impact of intraoperative hypotension on hospital stay in major abdominal surgery [J]. J Anesth, 2011, 25(4): 492-499.
24	马正良, 王天龙, 王东信, 等. 围手术期高血压患者管理专家共识(2014版)[EB/OL]. URL
25	Sousa-Uva M, Head SJ, Milojevic M, et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery [J]. Eur J Cardiothorac Surg, 2018, 53(1): 5-33.
26	Kristensen SD, Knuuti J. New ESC/ESA guidelines on non-cardiac surgery: cardiovascular assessment and management [J]. Eur Heart J, 2014, 35(35): 2344-2345.
27	黄震华. 围手术期高血压的治疗 [J]. 中国新药与临床杂志, 2009, 28(5): 329-332.
28	李军. 围术期高血压管理专家共识 [J]. 临床麻醉学杂志, 2016, 32(3): 295-297.
29	Reich DL, Bennett-Guerrero E, Bodian CA, et al. Intraoperative tachycardia and hypertension are independently associated with adverse outcome in noncardiac surgery of long duration [J]. Anesth Analg, 2002, 95(2): 273-277.
30	Monk TG, Bronsert MR, Henderson WG, et al. Association between intraoperative hypotension and hypertension and 30-day postoperative mortality in noncardiac surgery [J]. Anesthesiology, 2015, 123(2): 307-319.
31	Sessler DI, Bloomstone JA, Aronson S, et al. Perioperative quality initiative consensus statement on intraoperative blood pressure, risk and outcomes for elective surgery [J]. Br J Anaesth, 2019, 122(5): 563-574.

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Changes of blood pressure in elderly hypertensive patients during perioperative period

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Changes of blood pressure in elderly hypertensive patients during perioperative period