衰弱状态对择期手术患者术中低血压事件发生率的影响：Hypo-Frail单中心回顾性队列研究
贵州医科大学 麻醉与心脏电生理课题组
翻译：周倩 编辑：周倩 审校：曹莹
衰弱是老年患者发病率和死亡率的重要预测因子。本研究探讨了衰弱状态对术中低血压（IOH）发生可能性、频率、持续时间和严重程度的影响，IOH可导致严重的器官功能障碍。
方法
回顾性分析了70岁及以上、术前完成衰弱评估的择期手术患者。衰弱状态根据改良Fried标准分为稳健、衰弱前期和衰弱。IOH定义为平均动脉压（MAP）<65 mmHg。采用逻辑回归和泊松回归分析IOH的发生可能性、频率、持续时间和严重程度。
结果
本研究共纳入2495例患者。衰弱状态与IOH发生可能性无显著关联。数据显示：在手术过程中，衰弱前期患者的IOH发生率上升了9%（发病率比[IRR] 1.09 [95%置信区间1.03-1.16]，P=0.002），而衰弱患者的IOH发生率则增加了16%（IRR1.16[1.04-1.29]，P=0.007）。麻醉诱导阶段，衰弱前期患者的IOH发生率更是飙升28%（IRR1.28[1.12-1.47]，P<0.001)。值得注意的是，虽然手术或麻醉诱导时长与IOH严重程度无明显关联，但衰弱状态会导致麻醉诱导期间的IOH时间加权持续时间延长15%（IRR1.15[1.06-1.24]，P=0.001）。通过中介效应分析发现，在考虑测量血压次数和手术时长后，衰弱状态对IOH频率的影响超过90%；若进一步纳入丙泊酚总剂量因素，衰弱状态对IOH频率的影响超过70%。
与稳健患者相比，年龄＞70岁的衰弱前期和衰弱患者在手术期间的IOH增加16%，麻醉诱导期间则增加28%。术前优化（如预康复）和术中管理调整（如有创血压监测）可能减少这类患者的IOH风险。本研究首次将衰弱状态识别为IOH的危险因素，但需前瞻性研究进一步验证。
原始文献：Daum N, Hoff L, Spies C, et. Influence of frailty status on the incidence of intraoperative hypotensive events in elective surgery: Hypo-Frail, a single-centre retrospective cohort study. Br J Anaesth. 2025 Jul;135(1):40-47.
Influence of frailty status on the incidence of intraoperative hypotensive events in elective surgery: Hypo-Frail, a single-centre retrospective cohort study
ABSTRACT
Background: Frailty is a predictor of morbidity and mortality in older patients. This study aimed to investigate the influence of frailty status on likelihood, rate, duration, and severity of intraoperative hypotension (IOH), which can lead to severe organ dysfunction.
Methods: Surgical patients (≥70 yr old) with preoperative frailty assessment were analysed retrospectively. Frailty status was defined as robust, prefrail, or frail based on modified Fried criteria. IOH was defined as mean arterial pressure <65 mm Hg. For likelihood, rate, duration, and severity of IOH, logistic and Poisson regression were used.
Results: We included 2495 patients. There was no significant difference in likelihood of IOH. An increase of 9% in rate of IOH during surgery for prefrail (incidence rate ratio [IRR] 1.09 [95% CI 1.03-1.16], P=0.002), and 16% increase for frail patients (IRR 1.16 [1.04-1.29], P=0.007) was observed. During anaesthesia induction, prefrail patients exhibited a 28% increase in IOH (IRR 1.28 [1.12-1.47], P<0.001). Although there were no differences in the severity of IOH if surgery or anaesthesia induction duration was taken into account, frailty status was associated with a 15% longer time-weighted duration of IOH during anaesthesia induction (IRR 1.15 [1.06-1.24], P=0.001). Mediator analysis revealed that frailty status accounted for >90% after considering number of measured blood pressures and surgical duration and >70% after accounting for total propofol dose.
Conclusions: Prefrail and frail patients aged ≥70 yr experienced up to 16% more IOH during surgery and 28% more during anaesthesia induction compared with robust patients. Preoperative optimisation (prehabilitation) and modification of intraoperative management (e.g. invasive blood pressure management) have the potential to reduce IOH in prefrail and frail patients.