Risk Factors Analysis Of Tourniquet-induced Hypertension In Adults

Objective:Through retrospective analysis,the risk factors of tournique-induced hypertension（TIH）were explored to provide help for the anesthesia management during operation.Methods:From December 2021 to November 2022,the clinical data of 716 surgical patients who underwent extremity surgery and used tourniquet during surgery in Shengjing Hospital Affiliated to China Medical University were collected,of which 590cases met the inclusion and exclusion criteria.Recorded independent variable:gender,age（18≤age<45 years old is youth,45≤age<60 years is middle age,age≥60 years is old age）,Body Mass Index（BMI）,anesthesia method（general anesthesia or spinal anesthesia）,surgical site（upper limb or lower limb surgery）,surgical method（open surgery or minimally invasive surgery）,history of diabetes,history of hypertension,whether to use dexmedetomidine.According to the presence or absence of TIH as the dependent variable.Single factor analysis and binary logistic regression analysis was performed using SPSS 26.0 software.Univariate analysis was performed by chi-square test to examine the relationship between all independent and dependent variables.In order to avoid missing some important factors,P<0.1 was regarded as statistically significant in the process of univariate analysis.Significant independent variables were selected and included in the binary logistic regression model.Significant independent variables were included in the binary logistic regression model,and the OR and 95%confidence interval were calculated（P<0.05）.The Hosmer-Lemeshow goodness of fit test was used to analyze the goodness of fit of the model（P>0.05）.R language was used to construct the nomogram graph.The ROC curve was used to evaluate the reliability of the model.Then,the model was internally validated using 1000 bootstrap samples.Decision curve analysis was used to verify the clinical practicability nomogram.Results:1.Among the 590 patients in the study,219 cases developed TIH,the incidence rate was 37.1%,and 371 cases did not develop TIH,the incidence rate was 62.9%.Univariate analysis showed that age,obesity,general anesthesia,history of diabetes,history of hypertension,and open surgery had statistically significant effects on TIH（P<0.05）.Whether gender,surgical site,and whether to use dexmedetomidine had no statistically significant effects on TIH（P>0.1）.2.Logistic regression analysis of TIH risk factors showed:age(OR_middle-aged=2.714,95%CI_middle-aged:1.666-4.423,P<0.001;OR_old-age=3.256,95%CI_old-age:1.934-5.483,P<0.001),BMI（OR=1.849,95%CI:1.109～3.083,P=0.018）,general anesthesia（OR=15.901,95%CI:8.328～30.361,P<0.001）,diabetes（OR=2.368,95%CI:1.038～5.401,P=0.040）.In Hosmer-Lemeshow test model fitting degree,χ²=9.295,P=0.318>0.05,the model fitting degree is good.3.In this study,nomogram line plots were drawn for a multifactorial logistic regression model incorporating six indicators,including age,BMI,mode of anesthesia,mode of surgery,diabetes mellitus,and hypertension.The area under the model ROC curve（AUC）was0.791.The mean absolute error of the calibration curve was 0.012.Decision curve results show that this predictive model can provide significant additional clinical net benefit in predicting high risk of TIH in adult extremity surgery when the risk threshold is 0.1–0.8.Conclusion:Age,obesity,general anesthesia,and diabetes are independent risk factors for TIH.