Risk factors and prediction model establishment for hypotension induced by general anesthesia in elderly patients undergoing elective noncardiac surgery
Objective To explore the risk factors of hypotension induced by general anesthesia after elective noncardiac surgery in elderly patients and to establish a prediction model.Methods The clinical data of 407 elderly patients who underwent general anesthesia for elective noncardiac surgery in Qingpu Branch of Zhongshan Hospital Affiliated to Fudan University from February 2019 to May 2021 were retrospectively analyzed.The patients were divided into hypotensive group(blood pressure decreased by＞30％compared with the basic level after induction of general anesthesia or mean arterial pressure[MAP]＜60 mmHg[1 mmHg=0.133 kPa])and control group(blood pressure decreased by ≤30％and MAP≥60 mmHg).The general information such as age,height,weight,body mass index(BMI),hypertension,diabetes,coronary heart disease,and NYHA classification were collected.MAP at 5 min after entering operation room(MAPT0),MAP before intubation(MAPT1),preoperative blood glucose,triglyceride(TG),cholesterol(TC),low density lipoprotein(LDL)and high density lipoprotein(HDL),induction dose of propofol and sufentanil,ASA classification,the use of etomidate,and the magnitude of induced heart rate decline(ΔHR)were also recorded.Univariate and multivariate logistic regression analyses were performed to investigate the risk factors of hypotension induced by general anesthesia after elective noncardiac surgery in elderly patients.A predictive model was established on the basis of the risk factors and their coefficients.Results Among the 407 patients,211(51.84％)had hypotension induced by general anesthesia.The height and weight in the hypotensive group were significantly lower than those in the control group(P=0.007 and 0.017).The proportion of females,LDL,TC,the proportion of patients receiving etomidate,MAPT0 and ΔHR in the hypotensive group were significantly higher than those in the control group(P=0.019,0.004,0.022,0.015,and＜0.001).Variables with P＜0.1 in univariate analysis were included in logistic regression analysis,and the result showed that age,TC,sufentanil induction dose,MAPT0,and ΔHR were risk factors for hypotension during induction of general anesthesia in elderly patients undergoing noncardiac surgery.ROC curve was used to evaluate the accuracy of the model,with an AUC of 0.705(95％Cl:0.655-0.756,P＜0.001).Conclusion Age,TC,sufentanil induction dose,MAPT0,and ΔHR are risk factors for hypotension during induction of general anesthesia in elderly patients undergoing noncardiac elective surgery,and the prediction model based on these risk factors has a good accuracy in predicting hypotension.
Total cholesterolElderly patientsNoncardiac surgeryAnesthesia inductionHypotensionPrediction model
万方数据
维普
