目的 探讨低血压预测指数（HPI）引导下目标导向疗法对老年肺部手术患者术中低血压及术后急性肾损伤（AKI）发生的影响。 方法 选取2024年3月至2025年6月医院收治的144例老年肺部手术患者，按照随机数字表法分成常规组（72例）和研究组（72例）。常规组接受常规血压监测及管理，研究组开展HPI引导下目标导向疗法。比较两组围术期血压变化、术中低血压发生情况［发生率、持续总时间及低血压时间加权平均值（TWAH）］、血管活性药物（多巴酚丁胺、去甲肾上腺素）用量及术后转归指标［AKI发生率、重症监护室（ICU）停留时间与术后住院时间］。 结果 最终有141例（研究组70例，常规组71例）患者纳入研究。单肺通气后15 min、肺切除操作时及关胸时，研究组收缩压、平均动脉压均高于常规组，差异均有统计学意义（P < 0.05）。研究组术中低血压发生率、TWAH分别为17.14%、（0.25 ± 0.06），均低于常规组的32.39%、（0.37 ± 0.11），差异均有统计学意义（P < 0.05）。研究组多巴酚丁胺用量及去甲肾上腺素用量均多于常规组，差异均有统计学意义（P < 0.05）。研究组术后AKI发生率为1.43%，低于常规组的11.27%，差异有统计学意义（P < 0.05）。研究组低血压持续总时间、ICU停留时间、术后住院时间均短于常规组，差异均有统计学意义（P < 0.05）。 结论 HPI引导下目标导向疗法可减小老年肺部手术患者术中血压波动，降低术中低血压发生率及严重程度，减少术后AKI发生，促进术后恢复。

Objective To investigate the impact of goal-directed therapy guided by the Hypotension Prediction Index （HPI） on intraoperative hypotension and postoperative acute kidney injury （AKI） in elderly patients undergoing pulmonary surgery. Methods A total of 144 elderly patients who underwent pulmonary surgery and were admitted to our hospital from March 2024 to June 2025 were selected and divided into a conventional group （72 cases） and a study group （72 cases） using the random-number table method. The conventional group received routine blood-pressure monitoring and management， while the study group implemented HPI-guided goal-directed therapy. The perioperative blood-pressure variations， intraoperative hypotension （IOH） profiles ［including incidence， total duration， and time-weighted average of hypotension （TWAH）］， dosages of vasoactive agents （dobutamine and norepinephrine）， and postoperative outcomes ［incidence of AKI， intensive care unit （ICU） stay time， and postoperative hospital stay］ were compared between the two groups. Results Finally， a total of 141 patients were recruited for the study， with 70 in the study group and 71 in the conventional group. Fifteen minutes after one-lung ventilation， during pneumonectomy， and at the time of chest closure， the systolic blood pressure and mean arterial pressure in the study group were higher than those in the conventional group， and these differences were statistically significant （P < 0.05）. The incidence of intraoperative hypotension and the value of TWAH in the study group were 17.14% and （0.25 ± 0.06） respectively， which were lower than 32.39% and （0.37 ± 0.11） in the conventional group， and the differences were statistically significant （P < 0.05）. The dosages of dobutamine and norepinephrine in the study group were greater than those in the conventional group， and the differences were statistically significant （P < 0.05）. The incidence of postoperative AKI in the study group was 1.43%， which was lower than 11.27% in the conventional group， and this difference was statistically significant （P < 0.05）. The total duration of hypotension， ICU stay time， and postoperative hospital stay in the study group were shorter than those in the conventional group， and the differences were statistically significant （P < 0.05）. Conclusions The goal-directed therapy guided by HPI can mitigate intraoperative blood pressure fluctuation， lower the incidence and severity of intraoperative hypotension， diminish the occurrence of postoperative AKI， and facilitate postoperative recovery in elderly patients undergoing pulmonary surgery.