目的 分析在机器人辅助腹腔镜膀胱切除术患者应用低血压预测指数（HPI）进行术中血流动力学管理的经过，为同类型大手术的麻醉监测和血流动力学管理提供参考。 方法 回顾性分析1例采用HPI进行术中血流动力学管理的接受机器人辅助腹腔镜膀胱切除术患者的临床资料、术中血流动力学资料、血管活性药物用法用量和临床效果，并结合相关文献进行分析。 结果 患者，女性，72岁，因肉眼血尿5个月伴尿痛3个月入院。膀胱镜检查，膀胱三角区右侧可见7 cm×7 cm×5 cm肿物，近膀胱颈可见大小约4 cm×3 cm×3 cm肿物。正电子发射/计算机断层扫描（PET/CT）检查，膀胱右后壁增厚伴高代谢，初步诊断为膀胱恶性肿瘤。进行麻醉前评估后拟行机器人辅助腹腔镜膀胱切除术。患者入室后常规监测，同时采用搭载HPI软件的监护仪指导术中血流动力学管理。常规麻醉诱导后，使用可视喉镜进行气管插管。患者术中共发生低血压事件（IOH）6次，平均动脉压（MAP）<65 mmHg累计时间为13.7 min，占麻醉时长的4.4%，MAP<65 mmHg时间加权平均数为0.28 mmHg。HPI≥85的时间范围与MAP<65 mmHg大致重叠且包含后者。146个HPI≥85的时间点，68.5%（100/146）MAP>65 mmHg；47个MAP<65 mmHg的时间点，97.9%（46/47）均出现HPI≥85。患者术后第1天超敏肌钙蛋白I<0.01 μg·L^-1，未发生围术期不良事件，第8天顺利出院。 结论 HPI可及时并准确地预警机器人辅助腹腔镜膀胱切除术患者IOH的发生。术中使用基于HPI的低血压纠正策略可将患者MAP<65 mmHg的时间加权平均数维持在较低水平。

Objective To analyze the intraoperative hemodynamic management by hypotension prediction index （HPI） in one patient underwent robot-assisted laparoscopic cystectomy， and to provide the reference for anesthesia monitoring and hemodynamic management in the similar major surgery. Methods The clinical data， intraoperative hemodynamic data， usage and dosage of vasoactive drugs， and clinical outcomes of one patient underwent robot-assisted laparoscopic cystectomy with HPI-guided intraoperative hemodynamic management were retrospectively analyzed， and the relevant literatures were reviewed. Results The patient， a 72-year-old female， was admitted due to macroscopic hematuria for 5 months accompanied by dysuria for 3 months. The cystoscope results showed a 7 cm×7 cm×5 cm mass on the right side of the bladder trigone and a 4 cm×3 cm×3 cm mass near the bladder neck. The positron emission tomography/computed tomography （PET/CT） results showed thickening of the right posterior bladder wall with high metabolism， and the preliminary diagnosis was bladder malignancy. After preoperative anesthesia evaluation， the robot-assisted laparoscopic cystectomy was planned. After entering the operating room， the routine monitoring was conducted， and the monitor equipped with HPI software was used to guide intraoperative hemodynamic management. After routine anesthesia induction， the tracheal intubation was performed by video laryngoscope. The patient experienced intraoperative hypotension （IOH） for six times， the cumulative time of mean arterial pressure （MAP）<65 mmHg was 13.7 min， accounting for 4.40% of the anesthesia duration， and the time-weighted average of MAP<65 mmHg was 0.28 mmHg. The time range with HPI≥85 roughly overlapped with and included the period of MAP<65 mmHg. At 146 time points with HPI≥85，the MAP remained greater than 65 mmHg at 68.5% （100/146） of the points. At 47 time points with MAP<65 mmHg， HPI≥85 occurred at 97.9% （46/47） of the points. On the first postoperative day， the patient’s hypersensitive cardiac troponin I was <0.01 μg·L^-1， and no perioperative adverse events occurred. The patient was discharged on the eighth day. Conclusion HPI can promptly and accurately predict the occurrence of IOH in the patients undergoing robot-assisted laparoscopic cystectomy. The use of HPI-based hypotension correction strategies during surgery can maintain the time-weighted average of MAP<65 mmHg at a lower level.