發(fā)布時間：2018-03-27 12:43

  本文選題：高血壓　切入點：胃腸道腫瘤　出處：《臨床麻醉學(xué)雜志》2017年09期

【摘要】：目的探討高血壓患者胃腸道腫瘤手術(shù)前血壓控制對術(shù)后心血管不良事件的影響。方法選取擬行胃腸道腫瘤手術(shù)的高血壓患者238例,按既往口服降壓藥治療情況分為控制組(n=118)和未控制組(n=120)。術(shù)中采用相同麻醉方案,術(shù)后降壓藥使用同術(shù)前。記錄麻醉期間血管活性藥使用劑量,檢測術(shù)前、術(shù)后血胱抑素C(Cys C)、心肌肌鈣蛋白T(cTnT)以及術(shù)后第1、5天氨基末端B型利鈉肽前體(NT-proBNP)水平;記錄術(shù)后住院時間,隨訪患者出院后28、90d心血管不良事件。結(jié)果與未控制組比較,控制組術(shù)中麻黃堿總用量明顯減少[(3.41±1.04)mg vs(7.46±3.29)mg,P0.05],去氧腎上腺素總用量明顯減少[(0.17±0.10)mg vs(0.46±0.16)mg,P0.05],術(shù)后住院時間明顯縮短[(5.92±1.15)d vs(9.65±1.61)d,P0.05],控制組NT-proBNP在術(shù)后第1天[(108.00±47.11)pg/L vs(250.38±62.92)pg/L,P0.01]和術(shù)后第5天[(62.07±25.31)pg/L vs(199.02±60.32)pg/L,P0.01]均明顯降低。兩組患者術(shù)后Cys C和cTnT差異無統(tǒng)計學(xué)意義�？刂平M心血管不良事件發(fā)生率明顯低于未控制組(28d:13.6%vs 62.7%,90d:5.1%vs 23.3%,P0.05)。結(jié)論高血壓患者術(shù)前嚴(yán)格控制血壓能夠顯著降低術(shù)后心血管不良事件的發(fā)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 鹵1.04)mg vs(7.46 鹵3.29 vs(7.46 鹵3.29 mg / g P 0.05], the total dosage of noradrenaline was significantly decreased [0.17 鹵0.10)mg vs(0.46 鹵0.16 mg / g P 0.05], the postoperative hospitalization time was significantly shortened [5.92 鹵1.15 days vs(9.65 鹵1.61d P0.05], the NT-proBNP in the control group was significantly decreased on the first day after operation [108.00 鹵47.11)pg/L vs(250.38 鹵62.92 mg / LP0.01] and on the 5th day after operation [62.07 鹵25.31)pg/L vs(199.02 鹵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.
【作者單位】： 復(fù)旦大學(xué)附屬腫瘤醫(yī)院麻醉科復(fù)旦大學(xué)上海醫(yī)學(xué)院腫瘤學(xué)系;復(fù)旦大學(xué)附屬中山醫(yī)院麻醉科;
【分類號】：R614;R735
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本文編號：1671574