术中血压变异性对膝关节镜下前交叉韧带重建术止血带相关高血压的预测价值

The predictive value of intraoperative blood pressure variability for tourniquet-induced hypertension in anterior cruciate ligament reconstruction under knee arthroscopy

摘要:

目的 探讨术中血压变异性（BPV）对膝关节镜下前交叉韧带（ACL）重建术止血带相关高血压（TIH）的预测价值。方法 选取2023年1月－2024年9月该院收治的择期行膝关节镜下ACL重建术的患者129例，观察终点为患者术中发生TIH或手术结束。根据术中是否发生TIH，将患者分为TIH组（49例）和非TIH组（80例）。收集患者临床资料，计算并分析术中BPV相关指标。采用多因素Logistic回归模型，分析膝关节镜下ACL重建术后发生TIH的独立危险因素。绘制受试者操作特征曲线（ROC curve），并计算曲线下面积（AUC），分析术中BPV相关的预测价值。结果 最终纳入129例患者，发生TIH 49例，占比37.98%（49/129）。与非TIH组相比，TIH组止血带使用时间长，止血带压力高，收缩压变异系数（SBP-CV）和平均动脉压变异系数（MAP-CV）高，差异均有统计学意义（P < 0.05）。多因素Logistic回归分析结果显示：止血带压力 > 351 mmHg、SBP-CV > 8.72%和MAP-CV > 5.14%是膝关节镜下ACL重建术患者发生TIH的独立危险因素（P < 0.05）。ROC curve分析发现，SBP-CV和MAP-CV预测膝关节镜下ACL重建术患者发生TIH的AUC分别为0.787（95%CI：0.702～0.872）和0.791（95%CI：0.715～0.867）。结论 止血带压力、SBP-CV和MAP-CV与膝关节镜下ACL重建术患者发生TIH有关，且MAP-CV和SBP-CV对TIH均有良好的预测能力，可作为术后监测的重要指标。

Abstract:

Objective To investigate the predictive value of intraoperative blood pressure variability (BPV) for tourniquet-induced hypertension (TIH) in arthroscopic anterior cruciate ligament (ACL) reconstruction.Methods 129 patients who underwent arthroscopic ACL reconstruction from January 2023 to September 2024 were selected. The endpoint of observation was the occurrence of TIH or the end of operation. The patients were divided into the TIH group ( 49 cases ) and the non-TIH group ( 80 cases ) according to whether TIH occurred during operation. The clinical data of patients were collected, and the intraoperative BPV related indexes were calculated and analyzed. Multivariate Logistic regression analysis was used to analyze the risk factors of TIH in patients undergoing ACL reconstruction. The receiver operating characteristic curve (ROC curve) was drawn, and the area under the curve (AUC) was calculated to analyze the predictive value of BPV related indexes.Results 129 patients were included in this study, and 49 patients developed TIH, accounting for 37.98% (49/129). Compared with the non-TIH group, the tourniquet use time in the TIH group was significantly longer, the tourniquet pressure was significantly higher, the systolic blood pressure-coefficient of variation (SBP-CV) and mean arterial pressure-coefficient variation (MAP-CV) were significantly higher, the differences were statistically significant (P < 0.05). Multivariate Logistic regression analysis showed that tourniquet pressure > 351 mmHg, SBP-CV > 8.72 % and MAP-CV > 5.14 % were independent risk factors for TIH in patients undergoing arthroscopic ACL reconstruction (P < 0.05 ). ROC curve analysis showed that the AUC of SBP-CV and MAP-CV in predicting TIH in patients undergoing ACL reconstruction were 0.787 (95%CI: 0.702 ~ 0.872 ) and 0.791 (95%CI: 0.715 ~ 0.867), respectively.Conclusion Tourniquet pressure, SBP-CV and MAP-CV are related to TIH in patients undergoing arthroscopic ACL reconstruction, and MAP-CV and SBP-CV show good predictive ability for TIH, which can be used as an important indicator of postoperative monitoring.