文章摘要
术中不同血压管理策略对老年患者胃肠肿瘤根治术后心肌损伤的影响
Effects of different intraoperative blood pressure management strategy on postoperative myocardial injury in elderly patients undergoing radical surgery of gastrointestinal tumor
  
DOI：10.12089/jca.2021.03.010
中文关键词: 血压  心肌损伤  术后并发症  老年  腹部手术
英文关键词: Blood pressure  Myocardial injury  Postoperative complications  Elderly  Abdominal surgery
基金项目:安徽省重点研究与开发计划（201904a07020065）
作者单位E-mail
苏振宇 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科,麻醉与围术期医学安徽普通高校重点实验室（安徽医科大学）  
李锐 230601,合肥市,安徽医科大学第二附属医院麻醉与围术期医学科,麻醉与围术期医学安徽普通高校重点实验室（安徽医科大学） lrayd@sina.com 
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中文摘要:
      
目的 评价术中不同血压管理策略对老年患者胃肠肿瘤根治术后心肌损伤的影响。
方法 选择择期全麻下行腹腔镜胃肠肿瘤根治术患者96例，男65例，女31例，年龄65～80岁，BMI 18~26 kg/m2，ASA Ⅱ或Ⅲ级。采用随机数字表法分为两组：A组血压管理目标为术中SBP降低幅度小于基础值的20%且>90 mmHg，B组血压管理目标为SBP波动幅度小于基础值的10%。分别于麻醉诱导前和术后第1天采集患者静脉血测定血清心肌钙蛋白I（cTnI）及肌酸激酶同工酶（CK-MB）浓度，同时记录术后心肌缺血症状及心电图改变。
结果 与麻醉诱导前比较，术后第1天两组cTnI与CK-MB浓度明显升高（P<0.05）。术后第1天B组cTnI、CK-MB浓度及心肌损伤（cTnI>0.04 ng/ml）发生率明显低于A组（P<0.05）。
结论 术中维持SBP波动幅度小于基础值的10%有助于减少老年患者胃肠肿瘤根治术后心肌损伤的发生。
英文摘要:
      
Objective To evaluate the effects of different blood pressure management strategy on postoperative myocardial injury in elderly patients undergoing radical surgery of gastrointestinal tumor.
Methods Ninety-six elderly patients, scheduled for elective laparoscopic radical surgery of gastrointestinal tumor under general anesthesia, 65 males and 31 females, aged 65-80 years, BMI 18-26 kg/m2, ASA physical status Ⅱ or Ⅲ, were divided into two groups using a random number table: group A aimed at maintaining intraoperative SBP reducing less than 20% of the base value and above 90 mmHg, group B aimed at maintaining intraoperative SBP within 10% of the base value. Venous blood was taken to measure the concentration of serum cardiac troponin I (cTnI) and creatine kinase isoenzyme (CK-MB) before induction of anesthesia and day 1 morning after surgery to calculate the incidence of postoperative myocardial injury. The postoperative symptoms and electrocardiogram changes of myocardial ischemia were also recorded after the surgery.
Results The cTnI and CK-MB concentration of both groups were significantly increased postoperatively than before (P < 0.05). Compared with group A, the postoperative concentration of cTnI and CK-MB and the incidence of postoperative myocardial injury (cTnI > 0.04 ng/ml) were significantly lower in group B (P < 0.05).
Conclusion Maintaining intraoperative SBP within 10% of the reference value can help reduce the incidence of postoperative myocardial injury in elderly patients undergoing radical surgery of gastrointestinal tumor.
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