老年高血压合并胃肠道肿瘤患者术前血压控制的临床价值

Clinical significance of preoperative blood pressure control in elderly patients with hypertension complicated with gastrointestinal tumors

目的探讨胃肠道肿瘤合并高血压老年患者在胃肠道肿瘤手术前进行高血压控制的临床价值及对心血管不良反应发生的影响。方法选取2016年1月至2018年1月间湖北省应城市人民医院收治的90例行胃肠道肿瘤手术的胃肠道肿瘤合并高血压老年患者进行回顾性研究,将以往血压控制良好的42例患者纳入血压控制组,以往血压控制不好的48例患者纳入血压未控制组。记录两组患者术中麻醉使用血管活性药用量和住院时间,检测两组患者手术前后心肌肌钙蛋白T(cTnT)、胱抑素C(CysC)及术后1d和6d氨基末端B型利钠肽前体(NT-proBNP),并对患者进行3个月的随访,记录患者术后心血管不良反应发生情况。结果两组患者术中艾司洛尔用量比较,差异无统计学意义(P>0.05);血压控制组患者的麻黄碱、去氧肾腺素用量及住院时间均低于血压未控制患者,差异均有统计学意义(均P<0.05)。两组患者手术前后cTnT和CysC组间比较,差异无统计学意义(P>0.05)。血压控制组患者术后1d和6d的NT-proBNP水平均低于血压未控制组患者,差异均有统计学意义(均P<0.05)。血压控制组患者术后心血管不良反应发生率明显低于血压未控制组患者,差异有统计学意义(P<0.05)。结论胃肠道肿瘤合并高血压老年患者在胃肠道肿瘤手术前进行高血压控制,能减少术中使用血管活性药物用量和住院时间,降低患者术后心血管不良反应发生率。

Objective To explore the clinical significance of hypertension control in elderly patients with gastrointestinal neoplasms complicated with hypertension before operation and its influence on adverse cardiovascular reactions.Methods From January 2016 to January 2018,90,90 elderly patients with gastrointestinal cancer complicated with hypertension were selected and retrospectively analyzed at Yingcheng People＇s Hospital.Forty-two patients who had a good control of hypertension were included in the previous good blood pressure control group and 42 patients who had a poor control of blood pressure were included in the previous uncontrolled high blood pressure uncontrolled high blood pressure group（48 patients）.The dosage of vasoactive drugs during anesthesia and the duration of hospitalization were recorded.Cardiac troponin T（cTnT）,Cystatin C（CysC） and 1 d and 6 dN-terminal B-type natriuretic peptide precursor（NT-proBNP） after operation was measured before and after operation in both groups.The patients were followed up for 3 months to record the incidence of postoperative cardiovascular adverse reactions.Results There was no significant difference in the dosage of esmolol between the two groups（P〉0.05）,but the dosage of ephedrine and deoxyrenin and the length of hospitalization in the good control group were significantly lower than in the poor control group（P〈0.05）.There was no significant difference in cTnT and CysC between the two groups before and after operation（P〉0.05）,but the NT-proBNP level at 1 d and 6 d after operation in the good control group was significantly lower than that in the poor control group（all P〈0.05）.The incidence of postoperative cardiovascular adverse reactions in blood pressure good control group was significantly lower than in poor control group（P〈0.05）.Conclusion Hypertension control in the elderly patients with gastrointestinal tumors can reduce the use of vasoactive agents and time of hospitalization during the operation,and also reduce the incidence of postoperative cardiovascular adverse reactions.