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已发表论文
术中血压水平对体弱老年患者术后恢复的影响：一项随机对照试验
Authors Wang Y, Fan Q, Cheng Z, Xue X , Zhou Z, Liao M, Wang X, Li Y, Tian M, Zhang X
Received 12 July 2025
Accepted for publication 19 November 2025
Published 29 November 2025 Volume 2025:20 Pages 2255—2265
DOI https://doi.org/10.2147/CIA.S553244
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Zhi-Ying Wu
Yuxin Wang,1,* Qiannan Fan,1,* Zhi Cheng,1,* Xiang Xue,1 Zhou Zhou,2 Minhui Liao,3 Xinxin Wang,2 Yujie Li,2 Mi Tian,4 Xiaobao Zhang1,5
1Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, Maoming People’s Hospital, Maoming, Guangdong, People’s Republic of China; 4Department of Anesthesiology, Surgery and Pain Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 5Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiaobao Zhang, Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China, Tel +86 18961322507, Email hotdog100@163.com
Background: Frailty is a clinical syndrome characterized by a reduction in the functional capacity of multiple physiological systems, which increases the body’s vulnerability to stressors and reduces the capacity of elderly patients to recover from stressful events such as anesthesia and surgery.
Methods: A total of 142 elderly frailty patients scheduled for total knee arthroplasty were randomly assigned to either the low-level (Group L) or high-level group (Group H). Group L maintained intraoperative mean arterial pressure (MAP) at 65– 85 mmHg, while Group H targeted 85– 100 mmHg. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Secondary outcomes include the time-weighted average mean arterial pressure (TWA-MAP) intraoperatively, QoR-15 scores on POD2-5, the abbreviated mental test score (AMTS) at 30 days and 1-year postoperatively, the incidence of myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI), 1-year mortality postoperatively.
Results: There was no significant difference in QoR-15 values on POD1 between Group L and Group H (mean [SD] 99 [9.89] vs 98 [12.82], mean difference 95% confidence interval (CI) 0.91 (− 3.08– 4.91)). TWA-MAP was 93.1 ± 2.29 mmHg in Group H and 78.6 ± 2.97 mmHg in Group L (P < 0.05, mean difference 95% CI − 14.5 (− 15.4, − 13.6)), indicating a statistically significant difference between the two groups.
Conclusion: Maintaining higher or lower MAP intraoperatively had no significant effect on the quality of postoperative recovery in elderly frailty patients undergoing knee arthroplasty under the conditions studied in this trial.
Keywords: frailty, intraoperative mean arterial pressure, the quality of recovery-15, total knee arthroplasty
1Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China; 2Department of Anesthesiology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu, People’s Republic of China; 3Department of Anesthesiology, Maoming People’s Hospital, Maoming, Guangdong, People’s Republic of China; 4Department of Anesthesiology, Surgery and Pain Management, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, People’s Republic of China; 5Department of Anesthesiology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Xiaobao Zhang, Department of Anesthesiology, Lianyungang Clinical College of Nanjing Medical University, Lianyungang, Jiangsu, People’s Republic of China, Tel +86 18961322507, Email hotdog100@163.com
Background: Frailty is a clinical syndrome characterized by a reduction in the functional capacity of multiple physiological systems, which increases the body’s vulnerability to stressors and reduces the capacity of elderly patients to recover from stressful events such as anesthesia and surgery.
Methods: A total of 142 elderly frailty patients scheduled for total knee arthroplasty were randomly assigned to either the low-level (Group L) or high-level group (Group H). Group L maintained intraoperative mean arterial pressure (MAP) at 65– 85 mmHg, while Group H targeted 85– 100 mmHg. The primary outcome was the Quality of Recovery-15 (QoR-15) score on postoperative day (POD) 1. Secondary outcomes include the time-weighted average mean arterial pressure (TWA-MAP) intraoperatively, QoR-15 scores on POD2-5, the abbreviated mental test score (AMTS) at 30 days and 1-year postoperatively, the incidence of myocardial injury after noncardiac surgery (MINS) and acute kidney injury (AKI), 1-year mortality postoperatively.
Results: There was no significant difference in QoR-15 values on POD1 between Group L and Group H (mean [SD] 99 [9.89] vs 98 [12.82], mean difference 95% confidence interval (CI) 0.91 (− 3.08– 4.91)). TWA-MAP was 93.1 ± 2.29 mmHg in Group H and 78.6 ± 2.97 mmHg in Group L (P < 0.05, mean difference 95% CI − 14.5 (− 15.4, − 13.6)), indicating a statistically significant difference between the two groups.
Conclusion: Maintaining higher or lower MAP intraoperatively had no significant effect on the quality of postoperative recovery in elderly frailty patients undergoing knee arthroplasty under the conditions studied in this trial.
Keywords: frailty, intraoperative mean arterial pressure, the quality of recovery-15, total knee arthroplasty