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JAMA：个体化血压控制可降低大手术后器官衰竭风险

2017-10-11 zhangfan MedSci原创

器官衰竭血压围手术期
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研究认为，个体化的术后血压控制可以降低大手术后患者器官衰竭风险

围手术期血压与术后发病率和死亡率有关，但适当的血压管理策略仍不确定。近日研究人员考察了个体化生理血压管理策略是否能减少术后器官功能障碍风险。INPRESS研究为多中心、随机、对照临床研究，在法国9个医疗中心开展。298名成年术后急性肾衰竭高风险患者参与。患者随机进行个体化血压控制(即控制患者术后收缩压与静息收缩压差异10%以内)或者进行标准的血压控制（即收缩压低于80mmHg或术后4小时低于参考值的40%）。研究的主要终点是术后7天全身炎症反应综合征及肾、呼吸、心血管、凝血或神经系统功能障碍。次要终点包括手术后30天内的主要结果、ICU持续时间和住院时间、不良事件和全因死亡率。292名患者完成研究，平均年龄70岁，15.1%为女性。研究发现在147名个体化血压控制组中，56人(38.1%)发生了主要终点事件，而在145名标准治疗组中，75人(51.7%)发生了主要终点事件(rr 0.73；95% CI，0.56-0.94；P=0.02； 绝对风险差异-14%，95% CI，-25%--2%)。个体化组中68人(46.3%)，标准组中92人(63.4%) 在术后30天发生器官衰竭 (HR

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1721982, encodeId=26bd1e2198289, content=<a href='/topic/show?id=b73f43e1224' target=_blank style='color:#2F92EE;'>#大手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43712, encryptionId=b73f43e1224, topicName=大手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ecc933126179, createdName=Smile2691, createdTime=Mon Nov 13 12:56:00 CST 2017, time=2017-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435356, encodeId=7c3214353566f, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446294, encodeId=8fe8144629444, content=<a href='/topic/show?id=875e88946d1' target=_blank style='color:#2F92EE;'>#血压控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88946, encryptionId=875e88946d1, topicName=血压控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28a45200046, createdName=gj0733, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252173, encodeId=3eee2521e3e9, content=很好很好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Thu Oct 12 07:42:30 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251960, encodeId=de952519609b, content=大手术控制好血压, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Wed Oct 11 14:40:22 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251954, encodeId=8b8d251954c8, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Oct 11 14:06:58 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-11-13 Smile2691

    #大手术#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1721982, encodeId=26bd1e2198289, content=<a href='/topic/show?id=b73f43e1224' target=_blank style='color:#2F92EE;'>#大手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43712, encryptionId=b73f43e1224, topicName=大手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ecc933126179, createdName=Smile2691, createdTime=Mon Nov 13 12:56:00 CST 2017, time=2017-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435356, encodeId=7c3214353566f, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446294, encodeId=8fe8144629444, content=<a href='/topic/show?id=875e88946d1' target=_blank style='color:#2F92EE;'>#血压控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88946, encryptionId=875e88946d1, topicName=血压控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28a45200046, createdName=gj0733, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252173, encodeId=3eee2521e3e9, content=很好很好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Thu Oct 12 07:42:30 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251960, encodeId=de952519609b, content=大手术控制好血压, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Wed Oct 11 14:40:22 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251954, encodeId=8b8d251954c8, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Oct 11 14:06:58 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-13 zhouqu_8

    #个体化#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1721982, encodeId=26bd1e2198289, content=<a href='/topic/show?id=b73f43e1224' target=_blank style='color:#2F92EE;'>#大手术#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=39, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43712, encryptionId=b73f43e1224, topicName=大手术)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=ecc933126179, createdName=Smile2691, createdTime=Mon Nov 13 12:56:00 CST 2017, time=2017-11-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1435356, encodeId=7c3214353566f, content=<a href='/topic/show?id=9a5c212e88f' target=_blank style='color:#2F92EE;'>#个体化#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=28, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=21278, encryptionId=9a5c212e88f, topicName=个体化)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1446294, encodeId=8fe8144629444, content=<a href='/topic/show?id=875e88946d1' target=_blank style='color:#2F92EE;'>#血压控制#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=88946, encryptionId=875e88946d1, topicName=血压控制)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=28a45200046, createdName=gj0733, createdTime=Fri Oct 13 04:56:00 CST 2017, time=2017-10-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=252173, encodeId=3eee2521e3e9, content=很好很好很好, beContent=null, objectType=article, channel=null, level=null, likeNumber=84, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/07/8c1e5a0085f3b74f3a4ab58a38a3d487.jpg, createdBy=b33e2159612, createdName=2227437833_79976374, createdTime=Thu Oct 12 07:42:30 CST 2017, time=2017-10-12, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251960, encodeId=de952519609b, content=大手术控制好血压, beContent=null, objectType=article, channel=null, level=null, likeNumber=85, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=60791943465, createdName=1e0f8808m18(暂无匿称), createdTime=Wed Oct 11 14:40:22 CST 2017, time=2017-10-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=251954, encodeId=8b8d251954c8, content=谢谢分享.学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=79, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/Q3auHgzwzM4o2XVpJ6449yqDsjibydI5HnJ8MibGxNn4HZiaZib0bdfibbwoz3KQrIyN9AGxq36ZlZRNicYlPfOOWMtwgsajY6mGNFiaPclFdowjD0/0, createdBy=97bd1338592, createdName=清风拂面, createdTime=Wed Oct 11 14:06:58 CST 2017, time=2017-10-11, status=1, ipAttribution=)]
    2017-10-13 gj0733

    #血压控制#

    0

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    2017-10-12 2227437833_79976374

    很好很好很好

    0

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    2017-10-11 1e0f8808m18(暂无匿称)

    大手术控制好血压

    0

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    2017-10-11 清风拂面

    谢谢分享.学习了

    0

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