| 摘要: |
| 目的探讨术中平均动脉压（MAP）水平对老年高血压患者胃肠大手术后急性肾损伤（AKI）的影响。方法选取择期行全身麻醉下胃肠大手术老年高血压患者480例。采用随机数字表法将患者分为两组，各240例。Ⅰ组患者术中MAP控制为65～85mmHg，Ⅱ组患者术中MAP控制为86～100mmHg。观察并比较两组患者术中各指标、术后AKI发生率和住院情况。结果两组患者麻醉时间、手术时间和平衡液、胶体液、血浆、红细胞输注量及术中失血量比较均无统计学差异（均P＞0.05）。与Ⅰ组比较，Ⅱ组患者术中去甲肾上腺素、去氧肾上腺素和硝酸甘油等血管活性药物用量较大（均P＜0.05），术中心动过缓和房性早搏发生率亦较高（均P＜0.05），术后AKI发生率、术后收治住ICU率均较低（均P＜0.05），收治住ICU时间和住院时间均较短（均P＜0.05）。结论老年高血压患者胃肠大手术中维持较高MAP水平可降低术后AKI发生率，有利于患者肾功能保护。 |
| 关键词: 平均动脉压 高血压 急性肾损伤 老年 |
| DOI：10.12056/j.issn.1006-2785.2017.39.24.2016-2172 |
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| Impact of intraoperative mean arterial pressure on postoperative acute kidney injury in elderly patients with hypertension |
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Shaoxing People's Hospital
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| Abstract: |
| Objective To investigate the impact of intraoperative mean arterial pressure (MAP) on postoperative acute kidney injury (AKI) during major gastrointestinal surgery in elderly patients with chronic hypertension. Methods Four hundred and eighty elderly patients with chronic hypertension undergoing gastrointestinal surgery were randomly allocated to two groups with 240 in each group: in group I the intraoperative MAP of patients was controlled to 65~85 mmHg and in group Ⅱ the intraoperative MAP was controlled to 86~100 mmHg. Intraoperative parameters, postoperative AKI occurrence and length of hospital stay were observed and compared between two groups. Results There were no significant differences in anesthesia
time, duration of surgery and volume of crystalloids, colloids, plasma and red blood cell infusion, and intraoperative blood loss between two groups (all P ＞0.05). Compared to groupⅠ, group Ⅱ had higher doses of norepinephrine, phenylephrine and nitroglycerin (all P＜0.05). Consequently, group Ⅱ had more frequent intraoperative sinus bradycadia and premature atrial beats (all P＜0.05). However, compared to groupⅠ, there were lower incidence of postoperative AKI and rate of ICU admission, and shorter length of ICU stay and hospital stay (all P ＜0.05) in group Ⅱ . Conclusion For elderly patients with hypertension undergoing gastrointestinal surgery, maintaining a higher intraoperative MAP level decreases postoperative AKI rate and confers beneficial effect on kidney function. |
| Key words: Mean arterial pressure Hypertension Acute kidney injury Elderly |
