低血压预测指数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发生的影响

doi:10.3969/j.issn.1006-5725.2026.15.004

Abstract

Abstract:

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.

Key words: hypotension prediction index, goal-oriented therapy, old age, lung surgery, hypotension, acute kidney injury

CLC Number:

R734.2

Qing SHAN,Yi GAO,Chengcheng ZHANG,Meng HOU. The effect of goal-directed therapy guided by hypotension prediction index on intraoperative hypotension and postoperative AKI in elderly patients undergoing lung surgery[J]. The Journal of Practical Medicine, 2026, 42(15): 2698-2705.

Figures/Tables 8

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References 25

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项目	研究组（n = 70）	常规组（n = 71）	χ²/t/Z值	P值
性别/例			0.184	0.668
男	31	34
女	39	37
年龄/岁	70.47 ± 2.94	71.13 ± 3.05	1.308	0.193
体质量指数/（kg/m²）	22.53 ± 1.81	22.39 ± 1.77	0.464	0.643
合并疾病/［例（%）］
高血压	23（32.86）	26（36.62）	0.220	0.639
糖尿病	8（11.43）	6（8.70）	0.287	0.592
冠心病	12（17.14）	16（22.54）	0.644	0.422
有吸烟史/［例（%）］	19（27.14）	23（32.39）	0.465	0.495
具体手术/例			0.486	0.784
肺叶切除术	41	39
楔形切除术	21	23
全肺切除术	8	9
ASA分级/［例（%）］			1.199	0.230
Ⅰ级	18	25
Ⅱ级	42	38
Ⅲ级	10	8
手术时间［M（P₂₅，P₇₅）］/h	2.50（1.70，3.30）	2.40（1.80，3.10）	0.390	0.697
麻醉时间［M（P₂₅，P₇₅）］/h	2.80（1.90，3.60）	2.60（2.10，3.40）	0.596	0.552
术中失血量/mL	173.31 ± 29.24	175.86 ± 31.07	0.502	0.617
术中BIS	48.31 ± 2.17	47.79 ± 2.05	1.463	0.146
术前血清肌酐/（μmol/L）	73.56 ± 7.41	72.49 ± 6.75	0.897	0.371
术前血清尿素氮/（mmol/L）	4.81 ± 0.62	4.73 ± 0.58	0.791	0.430

项目	例数	麻醉诱导前5 min	单肺通气后15 min	肺切除操作时	关胸时	F值	P值
收缩压
研究组	70	118.35 ± 6.51	108.69 ± 5.04^*	106.85 ± 4.91^*	105.72 ± 4.02^*	F_组间=69.969，F_时间=271.341， F_交互=11.978	均P < 0.001
常规组	71	119.21 ± 6.83	103.47 ± 4.81^*	101.28 ± 4.67^*	100.95 ± 4.25^*
t值		0.765	6.292	6.903	6.845
P值		0.445	< 0.001	< 0.001	< 0.001
舒张压
研究组	70	75.83 ± 3.23	70.41 ± 2.89^*	69.73 ± 2.46^*	68.21 ± 2.35^*	F_组间=0.938，F_时间=236.568， F_交互=1.488	P_组间=0.422，P_时间< 0.001，F_交互=0.962
常规组	71	76.49 ± 3.47	70.26 ± 2.83^*	69.54 ± 2.27^*	67.89 ± 2.06^*
t值		1.169	0.311	0.477	0.860
P值		0.245	0.756	0.634	0.391
MAP
研究组	70	92.16 ± 4.59	85.75 ± 3.62^*	84.28 ± 3.27^*	84.06 ± 3.21^*	F_组间=112.289，F_时间=282.481， F_交互=20.171	均P < 0.001
常规组	71	93.04 ± 4.83	81.22 ± 3.25^*	79.73 ± 3.02^*	79.21 ± 2.96^*
t值		1.109	7.821	8.585	9.329
P值		0.269	< 0.001	< 0.001	< 0.001

组别	例数	术中低血压发生率 /［例（%）］	低血压持续总时间/min	TWAH /mmHg
研究组	70	12（17.14）	3.86 ± 1.07	0.25 ± 0.06
常规组	71	23（32.39）	11.72 ± 2.15	0.37 ± 0.11
χ²/t值		4.394	27.421	8.025
P值		0.036	< 0.001	< 0.001

组别	例数	多巴酚丁胺用量/mg	去甲肾上腺素用量/μg	总补液量/mL
研究组	70	10.36 ± 2.07	216.14 ± 39.35	1 356.24 ± 213.14
常规组	71	2.21 ± 0.64	187.33 ± 43.14	1 329.81 ± 209.75
t值		31.677	4.141	0.742
P值		< 0.001	< 0.001	0.459

组别	例数	AKI诊断类型
组别	例数	基于肌酐	基于尿量	总发生率
研究组	70	0（0.00）	1（1.43）	1（1.43）
常规组	71	3（4.23）	5（7.04）	8（11.27）
χ²_校正值				4.183
P值				0.041

The effect of goal-directed therapy guided by hypotension prediction index on intraoperative hypotension and postoperative AKI in elderly patients undergoing lung surgery

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组别	例数	ICU停留时间/h	术后住院时间/d	术后1个月内死亡/［例（%）］
研究组	70	20.37 ± 3.85	7.22 ± 1.64	0（0.00）
常规组	71	23.49 ± 4.32	8.36 ± 1.71	1（1.41）
t/χ²值		4.525	4.039	-
P值		< 0.001	< 0.001	1.000

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