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

摘要

Objective To study the effect of preoperative blood pressure control on postoperative cardiovascular events in patients with hypertension and gastrointestinal surgery. Methods A total of 238 hypertensive patients who underwent gastrointestinal surgery were selected and divided into control group (n =118)and non-control group (n =120)according to thehypotensor treatment.During the operation,the same anesthetic regimen was used.The use of vasoactive drugs was recorded during anesthesia.Bladder chalone C (Cys C)and cardiac troponin T (cTnT)were de-tected in blood before and after the operation,and so were N-terminal B type natriuretic peptide (NT-proBNP)level on the 1st and 5th day after the operation.The postoperative hospitalization time,fol-low-up of cardiovascular events 28 and 90 days after discharge were recorded.Results Compared with the non-control group,the total dosage of ephedrine in the control group was significantly re-duced [(3.41±1.04)mg vs (7.46 ± 3.29)mg,P <0.05 ],total dose of phenylephrinewas signifi-cantly reduced [(0.17±0.10)mg vs (0.46 ±0.16)mg,P <0.05],postoperative hospital stay was significantly shorter [(5.92±1.15)d vs (9.65±1.61)d,P <0.05],NT-proBNP level in the control group on the 1st day after the operation [(108.00 ± 47.11 )pg/L vs (250.38 ± 62.92 )pg/L,P <0.01]and 5 days after the operation [(62.07 ±25.31)pg/L vs (199.02 ± 60.32)pg/L,P <0.01 ] was obviously reduced.There was no statistical difference in Cys C andcTnT between the two group-safter operation.The incidence of cardiovascular adverse events in the control group was significantly lower than that in the non-control group (28 d:13.6% vs 62.7%,90 d:23.3% vs 23.3%,P <0.05).Conclusion Strict control of preoperative blood pressure control in patients with hypertension can significantly reduce the incidence of cardiovascular events.%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、90 d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,P<0.05],去氧肾上腺素总用量明显减少[(0.17±0.10)mg vs(0.46±0.16)mg,P<0.05],术后住院时间明显缩短[(5.92±1.15)d vs(9.65±1.61)d,P<0.05],控制组NT-proBNP在术后第1天[(108.00±47.11)pg/L vs(250.38±62.92)pg/L,P<0.01]和术后第5天[(62.07±25.31)pg/L vs(199.02±60.32)pg/L,P<0.01]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(28 d:13.6%vs 62.7%,90 d:5.1%vs 23.3%,P<0.05).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.