Tight perioperative blood pressure management to reduce complications: a randomised feasibility trial

医学 围手术期 血压 麻醉 平均动脉压 随机对照试验 外科 内科学 心率
作者
Kai Li,Zhouting Hu,Wangyu Li,Karan Shah,Daniel I. Sessler
出处
期刊:BMJ Open [BMJ]
卷期号:13 (11): e071328-e071328 被引量:2
标识
DOI:10.1136/bmjopen-2022-071328
摘要

Evaluate the feasibility of a trial of perioperative hypotension and serious complications.A patient and assessor-blinded randomised feasibility trial.We included patients in a tertiary university hospital.We enrolled 80 adults scheduled for major non-cardiac surgery.In patients randomised to tight blood pressure control, intraoperative mean arterial pressure (MAP) was targeted to ≥85 mm Hg maintained with norepinephrine infusion, and restarting chronic antihypertensive medications was delayed until the third postoperative day. In the reference group, intraoperative blood pressure was managed per routine and antihypertensive medications were restarted immediately after surgery.Our first co-primary outcome was the fraction of time when intraoperative MAP was >85 mm Hg, intraoperative area (time integral) of MAP >85 mm Hg and MAP <65 mm Hg. The second co-primary outcome was time until antihypertensive medications were restarted after surgery. Secondary outcomes were time-weighted average intraoperative MAP, cumulative minimum MAP for 10 min, average postoperative systolic blood pressure (SBP) and mean of the lowest three postoperative SBPs.Forty patients in each group were analysed. The median for intraoperative area of MAP >85 mm Hg was 1303 (772-2419) mm Hg*min in routine blood pressure (BP) cases and 2425 (1926-3545) mm Hg*min in tight BP control. The area for intraoperative MAP <65 mm Hg was 7 (0-40) mm Hg*min with routine BP management, and 0 (0-0) mm Hg*min with tight BP control. The fraction of time with MAP >85 mm Hg was 0.52 (0.25) and 0.87 (0.15). Antihypertensive medications were restarted 2 (1-3) days later in tight BP control cases. However, postoperative SBPs were similar.Tight BP management markedly increased intraoperative MAP and reduced the amount of hypotension. In contrast, delaying chronic antihypertensive medications had little effect on postoperative SBP. The full trial appears feasible and remains necessary but should not include postoperative antihypertensive management.NCT04789733.
最长约 10秒,即可获得该文献文件

科研通智能强力驱动
Strongly Powered by AbleSci AI
科研通是完全免费的文献互助平台,具备全网最快的应助速度,最高的求助完成率。 对每一个文献求助,科研通都将尽心尽力,给求助人一个满意的交代。
实时播报
keke发布了新的文献求助10
刚刚
issmoon关注了科研通微信公众号
刚刚
dummer发布了新的文献求助10
刚刚
红星路吃饼子的派大星完成签到 ,获得积分10
1秒前
heady完成签到,获得积分10
2秒前
3秒前
小二郎应助ccc采纳,获得10
3秒前
d22110652发布了新的文献求助10
3秒前
笑靥发布了新的文献求助10
3秒前
4秒前
4秒前
4秒前
4秒前
小王同学完成签到 ,获得积分10
5秒前
5秒前
默默问晴发布了新的文献求助10
5秒前
干秋白发布了新的文献求助10
6秒前
6秒前
番豆完成签到,获得积分10
7秒前
英姑应助汎影采纳,获得10
7秒前
7秒前
8秒前
YBW发布了新的文献求助10
8秒前
xuanye完成签到,获得积分10
8秒前
8秒前
9秒前
听雪发布了新的文献求助10
9秒前
无情山水发布了新的文献求助10
9秒前
10秒前
10秒前
实验狗发布了新的文献求助10
11秒前
Jerry20184完成签到 ,获得积分10
11秒前
11秒前
元羞花发布了新的文献求助10
11秒前
11秒前
干秋白完成签到,获得积分10
11秒前
11秒前
连冷安发布了新的文献求助10
12秒前
xy820发布了新的文献求助10
12秒前
13秒前
高分求助中
Production Logging: Theoretical and Interpretive Elements 2500
Healthcare Finance: Modern Financial Analysis for Accelerating Biomedical Innovation 2000
Applications of Emerging Nanomaterials and Nanotechnology 1111
Agaricales of New Zealand 1: Pluteaceae - Entolomataceae 1040
Les Mantodea de Guyane Insecta, Polyneoptera 1000
Neuromuscular and Electrodiagnostic Medicine Board Review 700
Crystal structures of UP2, UAs2, UAsS, and UAsSe in the pressure range up to 60 GPa 570
热门求助领域 (近24小时)
化学 医学 材料科学 生物 工程类 有机化学 生物化学 纳米技术 内科学 物理 化学工程 计算机科学 复合材料 基因 遗传学 物理化学 催化作用 细胞生物学 免疫学 电极
热门帖子
关注 科研通微信公众号,转发送积分 3467902
求助须知:如何正确求助?哪些是违规求助? 3060792
关于积分的说明 9073352
捐赠科研通 2751341
什么是DOI,文献DOI怎么找? 1509629
科研通“疑难数据库(出版商)”最低求助积分说明 697393
邀请新用户注册赠送积分活动 697393