低血压预测指数指导的血流动力学管理对老年患者术中低血压事件的影响OA

Objective This study aimed to compare the effects of hypotension prediction index(HPI)-guided hemodynamic management(HPI group)versus traditional haemodynamic management(control group)on intraoperative hypotensive events and postoperative recovery in elderly patients undergoing major abdominal surgery.Methods Elderly patients aged≥65 years undergoing major abdominal surgery under general anesthesia were enrolled.Patients were randomly divided into HPI group or control group using a random number table.In the HPI group,when the HPI exceeded 85,the HemoSphere monitor would trigger an alarm,the anesthesiologist formulated treatment plan based on advanced hemodynamic parameters,including administration of vasoconstrictors,fluid resuscitation,inotropic agents,or observation.In the control group,when MAP dropped below 65 mmHg,anesthesiologists managed hemodynamics based on the commonly used parameters of the HemoSphere monitor.Outcome measures recorded in both groups included the incidence of intraoperative hypotensive events,fluid intake and output,dosage of vasoactive drugs,postoperative mechanical ventilation duration,length of ICU stay,postop-erative hospital stay,and incidence of postoperative complications.Results A total of 64 elderly patients undergo-ing major abdominal surgery under general anesthesia were included in this study,comprising 39 males and 25 females,with ages ranging from 65 to 86 years and a body mass index(BMI)of 16.65～29.22 kg/m2.The HPI group had a significantly lower incidence of intraoperative hypotension than the control group(37.5%vs.65.6%,respectively;relative risk=0.558;95%confidence interval:0.325～0.957,P=0.024).Additionally,the HPI group exhibited lower values for time-weighted average MAP<65 mmHg(TWA-MAP<65 mmHg),area under the curve of MAP<65 mmHg(AUC-MAP<65 mmHg),and duration of MAP<65 mmHg compared with the con-trol group(all P<0.05).Compared with the control group,the HPI group had significantly reduced intraoperative colloid fluid infusion and total fluid input(P=0.037 and P=0.039,respectively)and a shorter postoperative mechanical ventilation duration(P=0.031).No statistically significant difference were observed between the two groups in the dosage of vasoactive drugs or incidence of postoperative complications(both P>0.05).Conclusions Compared with control group,HPI-guided hemodynamic management significantly reduces the incidence of intraop-erative hypotension events in elderly patients undergoing major abdominal surgery.Furthermore,HPI-guided hemo-dynamic management offers additional clinical benefits,including alleviating the duration and severity of intraop-erative hypotension,reducing intraoperative colloid and total fluid infusion,and shortening postoperative mechanical ventilation duration.