预防性用药对肿瘤术后高血压患者血流动力学的影响

Effect of preventive medications on hemodynamics in patients with postoperative hypertension

目的探讨预防性用药对肿瘤术后高血压患者血流动力学指标的影响。方法选取2016年2月至2019年2月间陕西省延安市志丹县人民医院收治的行手术治疗的79例肿瘤合并高血压患者,依据采用高血压药物的时间不同进行分组,术前预防性服用高血压药物的39例患者纳入试验组,术后服用高血压药物的40例患者纳入对照组。比较两组患者手术开始、手术30min及手术结束的平均脉压差(MAP)和心率(HR),比较两组患者术前及术后心肌肌钙蛋白T(c Tn T)和胱抑素C(Cys C)水平,比较术前、术后1天及术后5天两组患者氨基末端B型利钠肽前体(NT-proBNP)水平,比较两组患者术后6个月各类心血管事件发生率。结果手术开始时,两组患者MAP及HR比较,差异无统计学意义(P>0.05)。手术30min及手术结束时,两组患者MAP及HR均较手术开始时升高,试验组MAP及HR均低于对照组,差异均有统计学意义(均P<0.05)。两组患者术前及术后c Tn T和Cys C水平比较,差异无统计学意义(P>0.05)。两组患者术前NT-proBNP水平比较,差异无统计学意义(P>0.05)。术后1天及5天时,试验组患者NT-proBNP水平均低于对照组患者,差异均有统计学意义(均P<0.05)。试验组患者术后6个月内各类心血管事件发生率为7.7%,低于对照组的25.0%,差异有统计学意义(P<0.05)。结论对实施肿瘤切除术的高血压患者预防性采用高血压药物,能稳定患者术中及术后血压及心率,降低其术后NT-proBNP水平及不良心血管事件发生率。

Objective To explore the effect of preventive medication on hemodynamics in patients with postoperative hypertension.Methods A total of 79 patients with cancer complicated with hypertension who underwent surgery at Zhidan County People’s Hospital from February 2016 to February 2019 were selected as subjects.They were divided into an experimental group(39 patients)and a control group(40 patients).The experimental group preoperatively received prophylactic antihypertensive drugs,and the control group received antihypertensive drugs after the operation.Mean pulse pressure difference(MAP)and heart rate(HR)at the beginning of the surgery 30 min and end of the surgery were compared between the two groups.Preoperative and postoperative cardiac troponin T(c Tn T)and cystatin C were compared between the two groups.The level of amino-terminal B-type natriuretic peptide(NT-proBNP)was compared between the two groups before the surgery and at 1 d and 5 d after the surgery.The incidence of various cardiovascular events at 60 d after the surgery was compared between the two groups.Results There was no significant difference in MAP and HR between the two groups at the beginning of the surgery(P>0.05).At 30 min,MAP and HR began to increase.MAP and HR were lower in the experimental group than in the control group(P<0.05).There was no significant difference in the levels of c Tn T and Cys C between the two groups before and after surgery(P>0.05).The difference in NT-proBNP levels between the two groups was not statistically significant(P>0.05).The level of NT-proBNP was lower in the experimental group than in the control group at 1 d and 5 d after the surgery(all P<0.05).The incidence of adverse cardiovascular events was 7.7% in the experimental group which was lower than 25.0%in the control group at 60 d after the operation(P<0.05).Conclusion Prophylactic use of antihypertensive drugs can significantly stabilize intraoperative and postoperative blood pressure and heart rate,reduce postoperative NT-proBNP levels and incidence of adverse cardiovascular events in patients with hypertension undergoing tumor resection.