个体化血压管理对老年脊柱手术病人术后心肌损伤的影响  

Effect of individualized blood pressure management on postoperative myocardial injury in elderly patients undergoing spinal surgery

作　　者：杨小燕 嵇富海[2] 王玉兰[2] YANG Xiaoyan;JI Fuhai;WANG Yulan(Department of Anesthesiology,the People’s Hospital of Suzhou New District,Suzhou 215006,China;Department of Anesthesiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China)

机构地区：[1]苏州市高新区人民医院麻醉科,江苏省苏州市215006 [2]苏州大学附属第一医院麻醉科,江苏省苏州市215006

出　　处：《实用老年医学》2024年第12期1215-1219,共5页Practical Geriatrics

基　　金：江苏省卫生健康委科研项目(ZD2022021)。

摘　　要：目的探讨不同血压管理策略对老年脊柱手术病人术后心肌损伤的影响。方法选择60例全麻下行后路椎间融合术(PLIF)的老年病人,随机分为标准化血压管理组(S组)和个体化血压管理组(I组),每组30例。S组病人维持术中平均动脉压(MAP)不低于65 mmHg或降低不超过基础值的30%,I组维持MAP在基础值的90%~110%。记录2组病人术前访视时(T0)、麻醉前(T1)、手术开始时(T2)、椎管减压时(T3)、手术结束时(T4)和术后24 h(T5)的血压和心率,术前及术后24 h高敏肌钙蛋白T(hsTnT)、血肌酐(Cr)和BUN等指标。记录2组病人术后心肌损伤(MINS)的发生率。结果T3时,I组MAP高于S组,心率低于S组,差异均有统计学意义(P<0.05)。术中I组尿量多于S组(P<0.05)。术后24 h,I组hsTnT、Cr和BUN水平明显低于S组(P<0.05)。I组有2例(6.7%)病人发生了MINS,S组有10例(33.3%)病人发生了MINS,差异有统计学意义(P<0.05)。结论个体化血压管理策略能降低老年PLIF手术病人MINS的发生率,降低术后Cr和BUN水平。Objective To investigate the effects of different blood pressure(BP)management strategy on postoperative myocardial injury in the elderly patients undergoing spinal surgery.Methods A total of 60 elderly patients undergoing posterior lumbar interbody fusion(PLIF)surgery were randomly divided into standardized management group(group S,n=30)and individualized management group(group I,n=30).Group S maintained the level of intraoperative mean arterial pressure(MAP)at≥65 mmHg or maintained the decrease≤30%of the baseline level,and group I maintained MAP at 90%to 110%of the baseline level.The blood pressure and heart rate at preoperative visit(T0),before anesthesia(T1),at the beginning of surgery(T2),at the time of spinal decompression(T3),at the end of surgery(T4)and 24 h after surgery(T5)were recorded,and the levels of high sensitivity troponin T(hsTnT),serum creatinine(Cr)and blood urea nitrogen(BUN)were detected before and 24 h after surgery.The incidence of myocardial injury after non-cardiac surgery(MINS)was recorded in 2 groups.Results During the period of intraoperative spinal canal decompression,the level of MAP was significantly higher and the heart rate was significantly lower in group I than those in group S(P<0.05).The intraoperative urine volume in group I was higher than that in group S(P<0.05).The levels of hsTnT,Cr and BUN in group I were significantly lower than those in group S 24 h after operation(P<0.05).MINS occurred in 2 patients(6.7%)in group I and 10 patients(33.3%)in group S,with statistical difference(P<0.05).Conclusions Individualized BP management strategy can reduce the incidence of postoperative MINS in the elderly patients undergoing PLIF.It also reduces the levels of Cr and BUN.

关 键 词：血压管理 老年人 脊柱手术 心肌损伤 高敏肌钙蛋白T 

分 类 号：R619[医药卫生—外科学]