旨在评估主要针对癌症的大型非心脏手术后老年患者术中低血压与长期生存的关系。对三项随机试验的数据库进行二次分析并进行长期随访。基础试验是在 2017 年 17 家三级医院进行的。中国。本分析纳入了在单中心接受过重大非心脏胸腔或腹部手术（≥ 2 小时）的 60 至 90 岁患者。采用受限三次样条模型来确定最低平均动脉压 (MAP) 阈值，即对长期生存可能有害。根据累积持续时间或 MAP 阈值以下面积，将患者任意分为三组。使用 Cox 比例风险回归模型分析术中低血压暴露与长期生存率之间的关联。我们的主要终点是总生存率。次要终点包括无复发和无事件生存率。最终分析共纳入 2664 名患者（平均年龄 69.0 岁，34.9% 女性，92.5% 接受过癌症手术）。采用 MAP < 60 mmHg 作为术中低血压的阈值。根据 MA​​P < 60 mmHg 下的持续时间（<1 分钟、1-10 分钟和> 10 分钟）或 MAP <60 mmHg 下的面积（< 1 mmHg·min、1-30 mmHg·min、且> 30 mmHg·分钟）。调整混杂因素后，与 < 1 分钟的患者相比，MAP < 60 mmHg 持续时间 > 10 分钟与总生存期缩短相关（调整后的风险比 [HR] 1.31，95% 置信区间 [CI] 1.09 至 1.57，P = 0.004);与 < 1 mmHg·min 的患者相比，MAP < 60 mmHg 下面积 > 30 mmHg·min 与总生存期缩短相关（调整后 HR 1.40，95% CI 1.16 至 1.68，P < 0.001）。 MAP < 60 mmHg 下的持续时间 > 10 分钟或 MAP < 60 mmHg 下的面积 > 30 mmHg·min 与无复发或无事件生存期之间存在类似的关联。在主要因癌症而接受重大非心脏手术的老年患者中，术中低血压与较差的总体生存率、无复发率和无事件生存率相关。版权所有 © 2024 作者。由爱思唯尔公司出版。保留所有权利。

To assess the association of intraoperative hypotension with long-term survivals in older patients after major noncardiac surgery mainly for cancer.A secondary analysis of databases from three randomized trials with long-term follow-up.The underlying trials were conducted in 17 tertiary hospitals in China.Patients aged 60 to 90 years who underwent major noncardiac thoracic or abdominal surgeries (≥ 2 h) in a single center were included in this analysis.Restricted cubic spline models were employed to determine the lowest mean arterial pressure (MAP) threshold that was potentially harmful for long-term survivals. Patients were arbitrarily divided into three groups according to the cumulative duration or area under the MAP threshold. The association between intraoperative hypotension exposure and long-term survivals were analyzed with the Cox proportional hazard regression models.Our primary endpoint was overall survival. Secondary endpoints included recurrence-free and event-free survivals.A total of 2664 patients (mean age 69.0 years, 34.9% female sex, 92.5% cancer surgery) were included in the final analysis. MAP < 60 mmHg was adopted as the threshold of intraoperative hypotension. Patients were divided into three groups according to duration under MAP < 60 mmHg (<1 min, 1-10 min, and > 10 min) or area under MAP <60 mmHg (< 1 mmHg⋅min, 1-30 mmHg⋅min, and > 30 mmHg⋅min). After adjusting confounders, duration under MAP < 60 mmHg for > 10 min was associated with a shortened overall survival when compared with the < 1 min patients (adjusted hazard ratio [HR] 1.31, 95% confidence interval [CI] 1.09 to 1.57, P = 0.004); area under MAP < 60 mmHg for > 30 mmHg⋅min was associated with a shortened overall survival when compared with the < 1 mmHg⋅min patients (adjusted HR 1.40, 95% CI 1.16 to 1.68, P < 0.001). Similar associations exist between duration under MAP < 60 mmHg for > 10 min or area under MAP < 60 mmHg for > 30 mmHg⋅min and recurrence-free or event-free survivals.In older patients who underwent major noncardiac surgery mainly for cancer, intraoperative hypotension was associated with worse overall, recurrence-free, and event-free survivals.Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.