在脊柱麻醉下接受快速通道髋部骨折手术的老年患者术中低血压的风险因素:回顾性观察研究

Q3 Medicine Siriraj Medical Journal Pub Date : 2024-07-01 DOI:10.33192/smj.v76i7.269205
Samita Pirotesak, Waroonwan Neti, Phuengjai Weerapong, Bharadee Teeravidja, Pawinee Pangthipampai, Busara Sirivanasandha
{"title":"在脊柱麻醉下接受快速通道髋部骨折手术的老年患者术中低血压的风险因素:回顾性观察研究","authors":"Samita Pirotesak, Waroonwan Neti, Phuengjai Weerapong, Bharadee Teeravidja, Pawinee Pangthipampai, Busara Sirivanasandha","doi":"10.33192/smj.v76i7.269205","DOIUrl":null,"url":null,"abstract":"Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia.\nMaterials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension.\nResults: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033).\nConclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.","PeriodicalId":37270,"journal":{"name":"Siriraj Medical Journal","volume":"35 6","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study\",\"authors\":\"Samita Pirotesak, Waroonwan Neti, Phuengjai Weerapong, Bharadee Teeravidja, Pawinee Pangthipampai, Busara Sirivanasandha\",\"doi\":\"10.33192/smj.v76i7.269205\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia.\\nMaterials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension.\\nResults: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033).\\nConclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.\",\"PeriodicalId\":37270,\"journal\":{\"name\":\"Siriraj Medical Journal\",\"volume\":\"35 6\",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-07-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Siriraj Medical Journal\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.33192/smj.v76i7.269205\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Siriraj Medical Journal","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.33192/smj.v76i7.269205","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

摘要

目的:髋部骨折快速手术刻不容缓。有时间限制的术前优化会增加围术期心血管问题的风险,影响术后效果。本研究旨在确定接受脊髓麻醉快速通道髋部骨折手术的老年患者术中低血压的风险因素:这项回顾性观察分析在一家大学附属医院进行。研究人员检查了 2018 年至 2022 年的医疗记录,以比较与术中低血压相关的变量。采用多变量逻辑回归分析确定术中低血压的风险变量:结果:术中低血压发生率为50.1%。结果:术中低血压发生率为 50.1%,与术中低血压相关的重要因素包括既往中风病史(调整后的几率比 [OR]:2.41;95% 置信区间 [CI]:1.38-4.21,P<0.05):1.38-4.21,P = 0.002)、术前基线 SBP 低于 100 mmHg(调整 OR:2.34;95% CI:1.34-4.08,P = 0.003)、术前尿量少于 0.5 ml/kg/h(调整 OR:2.74;95% CI:1.07-6.96,P = 0.034)、接受髓内钉手术(调整 OR:2.64;95% CI:1.85-3.77,P <0.001)。相反,保护性因素包括术前输血(调整后OR值:0.43;95% CI:0.24-0.77,P = 0.004)和脊柱布比卡因剂量达到或超过7.5毫克(调整后OR值:0.59;95% CI:0.36-0.95,P = 0.033):可改变的因素包括确保术前有足够的血管内容量以优化尿量和血压,以及纠正贫血。对高危患者优先采取这些措施有助于预防复杂住院。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
Risk Factors for Intraoperative Hypotension in Elderly Patients Undergoing Fast Track Hip Fracture Surgery under Spinal Anesthesia: A Retrospective Observational Study
Objective: Fast-track hip fracture surgery is urgent. Time-limited preoperative optimization increase the risk of perioperative cardiovascular issues, affecting postoperative outcomes. This study aimed to identify risk factors for intraoperative hypotension in elderly patients undergoing fast-track hip fracture surgery with spinal anesthesia. Materials and Methods: This retrospective observational analysis was conducted at a university-based hospital. Medical records from 2018 to 2022 were examined to compare variables associated with intraoperative hypotension. Multivariate logistic regression analysis was used to determine the risk variables for intraoperative hypotension. Results: The incidence of intraoperative hypotension was 50.1%. Significant factors associated with intraoperative hypotension included a history of previous stroke (adjusted odds ratio [OR]: 2.41; 95% confidence interval [CI]: 1.38–4.21, P = 0.002), a preoperative baseline SBP below 100 mmHg (adjusted OR: 2.34; 95% CI: 1.34–4.08, P = 0.003), a preoperative urine output less than 0.5 ml/kg/h (adjusted OR: 2.74; 95% CI: 1.07–6.96, P = 0.034), undergoing an intramedullary nail procedure (adjusted OR: 2.64; 95% CI: 1.85–3.77, P < 0.001). Conversely, protective factors included receiving preoperative blood transfusions (adjusted OR: 0.43; 95% CI: 0.24–0.77, P = 0.004) and receiving a spinal bupivacaine dose of 7.5 mg or above (adjusted OR: 0.59; 95% CI: 0.36–0.95, P = 0.033). Conclusion: Modifiable factors include ensuring adequate preoperative intravascular volume to optimize urine output and blood pressure, and correcting anemia. Prioritizing these measures for at-risk patients can help prevent complicated hospital stays.
求助全文
通过发布文献求助,成功后即可免费获取论文全文。 去求助
来源期刊
Siriraj Medical Journal
Siriraj Medical Journal Medicine-Medicine (all)
CiteScore
0.90
自引率
0.00%
发文量
0
审稿时长
8 weeks
期刊最新文献
Incidences, Characteristics, Management and Outcomes of Different Subtypes of Postoperative Delirium in Elderly Patients Admitted to the Surgical Intensive Care Unit: A Secondary Analysis of a Prospective Cohort Study Optimizing Perioperative Care for Elderly Surgical Patients: A Review of Strategies and Evidence-Based Practices Comparison between the Standard Teaching and the Thai Version of Blended Teaching on Basic Airway Management in Siriraj Medical Students Analgesic Efficacy of Ultrasound-guided Fascia Iliaca Compartment Block (FICB) and Outcomes in Preoperative Fast-track Geriatric Patients with Hip Fracture: A Single-center Retrospective Study Effectiveness of Smartphone Applications vs Conventional Care in Warfarin Therapy: A Randomized Controlled Trial on the Time in the Therapeutic Range
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1