全麻诱导后低血压与胃肠道肿瘤手术后不良结局的相关性研究进展

Research Progress on the Association between Post-Induction Hypotension and Adverse Outcomes after Gastrointestinal Tumor Surgery

摘要: 全麻诱导后低血压(Post-Induction Hypotension, PIH)是围术期常见的血流动力学紊乱事件，在胃肠道肿瘤手术患者中发生率可高达39.9%。本文系统综述了PIH的定义、发生机制、对胃肠道肿瘤手术后短期及远期不良结局的影响、潜在生物学通路、危险因素与预测、预防与管理策略及预后模型构建等方面的最新研究进展。现有证据表明，PIH与术后死亡率、心肌损伤及肺部并发症等短期不良结局密切相关，虚弱状态、高龄、肠梗阻及麻醉药物(尤其是瑞芬太尼)是PIH的独立危险因素，而预防性使用去甲肾上腺素、液体预处理及气压腿套等干预措施可有效降低PIH发生率。超声评估ΔVTI-PLR (AUC = 0.89)及低血压预测指数HPI等工具为PIH的早期识别提供了技术支持。未来研究需统一PIH定义并开展大规模随机对照试验验证个体化干预策略的远期获益。

Abstract: Post-induction hypotension (PIH) is a common perioperative hemodynamic disturbance with an incidence up to 39.9% in patients undergoing gastrointestinal tumor surgery. This review systematically summarizes recent research progress on PIH definition, mechanisms, impacts on short- and long-term adverse outcomes, potential biological pathways, risk factors and prediction, prevention and management strategies, and prognostic model development. Current evidence indicates that PIH is closely associated with postoperative mortality, myocardial injury, and pulmonary complications. Risk factors include frailty, advanced age, bowel obstruction, and anesthetic agents (especially remifentanil). Preventive interventions such as norepinephrine administration, fluid preload, and pneumatic leg compression can effectively reduce PIH incidence. Ultrasound-based ΔVTI-PLR (AUC = 0.89) and the Hypotension Prediction Index (HPI) provide technical support for early PIH identification. Future studies should establish a unified PIH definition and conduct large-scale randomized controlled trials to validate long-term benefits of individualized intervention strategies.