高血压患者胃肠道肿瘤手术前血压控制对术后心血管不良事件的影响

发布时间：2018-03-27 12:43

  本文选题：高血压　切入点：胃肠道肿瘤　出处：《临床麻醉学杂志》2017年09期

【摘要】：目的探讨高血压患者胃肠道肿瘤手术前血压控制对术后心血管不良事件的影响。方法选取拟行胃肠道肿瘤手术的高血压患者238例,按既往口服降压药治疗情况分为控制组(n=118)和未控制组(n=120)。术中采用相同麻醉方案,术后降压药使用同术前。记录麻醉期间血管活性药使用剂量,检测术前、术后血胱抑素C(Cys C)、心肌肌钙蛋白T(cTnT)以及术后第1、5天氨基末端B型利钠肽前体(NT-proBNP)水平;记录术后住院时间,随访患者出院后28、90d心血管不良事件。结果与未控制组比较,控制组术中麻黄碱总用量明显减少[(3.41±1.04)mg vs(7.46±3.29)mg,P0.05],去氧肾上腺素总用量明显减少[(0.17±0.10)mg vs(0.46±0.16)mg,P0.05],术后住院时间明显缩短[(5.92±1.15)d vs(9.65±1.61)d,P0.05],控制组NT-proBNP在术后第1天[(108.00±47.11)pg/L vs(250.38±62.92)pg/L,P0.01]和术后第5天[(62.07±25.31)pg/L vs(199.02±60.32)pg/L,P0.01]均明显降低。两组患者术后Cys C和cTnT差异无统计学意义。控制组心血管不良事件发生率明显低于未控制组(28d:13.6%vs 62.7%,90d:5.1%vs 23.3%,P0.05)。结论高血压患者术前严格控制血压能够显著降低术后心血管不良事件的发生。
[Abstract]:Objective to investigate the effect of blood pressure control on postoperative cardiovascular adverse events in hypertensive patients with gastrointestinal neoplasms. Methods 238 patients with hypertension undergoing gastrointestinal cancer surgery were selected. According to the past treatment of oral antihypertensive drugs, they were divided into two groups: control group (n = 118) and control group (n = 120). The same anesthetic scheme was used during the operation, and the postoperative antihypertensive drugs were used the same as before. The dosage of vasoactive drugs during anesthesia was recorded and detected before operation. The levels of serum cystatin C(Cys, cardiac troponin TnT and NT-proBNPs on the 1st day after operation were recorded, the postoperative hospitalization time was recorded, and the adverse cardiovascular events of the patients were followed up at 2890 days after discharge. The results were compared with those in the control group. In the control group, the total dosage of ephedrine was significantly decreased [3.41 卤1.04)mg vs(7.46 卤3.29 vs(7.46 卤3.29 mg / g P 0.05], the total dosage of noradrenaline was significantly decreased [0.17 卤0.10)mg vs(0.46 卤0.16 mg / g P 0.05], the postoperative hospitalization time was significantly shortened [5.92 卤1.15 days vs(9.65 卤1.61d P0.05], the NT-proBNP in the control group was significantly decreased on the first day after operation [108.00 卤47.11)pg/L vs(250.38 卤62.92 mg / LP0.01] and on the 5th day after operation [62.07 卤25.31)pg/L vs(199.02 卤60.32pgL / P 0.01]. There was no significant difference in Cys C and cTnT between the two groups. The incidence of cardiovascular adverse events in the control group was significantly lower than that in the control group at 28 d: 13.6 vs 62.7d: 5.1 vs 23.3D: 0.050.Conclusion strict control of blood pressure before operation can significantly reduce the incidence of postoperative adverse cardiovascular events in patients with hypertension.
【作者单位】： 复旦大学附属肿瘤医院麻醉科复旦大学上海医学院肿瘤学系;复旦大学附属中山医院麻醉科;
【分类号】：R614;R735
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本文编号：1671574