| Objective: Intraoperative hypotension during surgery is common.Recent data suggest that hypotension in elderly patients during surgery is associated with perioperative complications and mortality.At present,some studies indicate that Continuous noninvasive blood pressure monitoring(CNBP)system,compared with standard non-invasive equipment,is more secure and advantageous to maintain stable intraoperative blood pressure.TL-300 is one of CNBP equipment,which can recognise and manage hypotension quickly.However,there are no data support tight blood pressure management can decrease postoperative complications and mortality.Therefore,the purpose of this study was to evaluate the effect of tight blood pressure management guided by TL-300 continuous non-invasive blood pressure monitoring system in the operative period on postoperative complications in elderly patients,and to provide a basis for tight intraoperative blood pressure management.Methods : 108 elderly patients from March 2018 to January 2019 undergoing surgery were selected,aged >65 years,all of them signed the informed consent.The patients were randomly divided into two groups by random number table method:group T and group C.The group T received tight blood pressure management guided by TL-300 continuous non-invasive blood pressure monitoring system.Hypertension and hypotension in this group should be treated as soon as it occured.While the group C received blood pressure management guided by standard non-invasive pressure monitoring with cuff every 5min.Hypertension refered to the blood pressure(BP)above 160/90 mmHg,while hypotension was defined as mean arterial pressure MAP < 65 mmHg.Patients in both groups were treated with general anesthesia.During the operation,Systolic blood pressure(SBP),Diastolic blood pressure(DBP)and Mean arterial pressure(MAP)were recorded every five minutes.Peripheral venous blood of the patients in the two groups was collected to detect Creatinine and troponin before the operation and at 24 h after operation,respectively.Acute kidney injury was defined as an increase in serum creatinine(sCr)by 1.5 times above baseline or ?0.3 mg/dl(?26.5 ?mol/L)increase.Incidence of myocardial injury defined as troponin >0.03 ng/ml.Postoperative delirium(POD)was assessed and recorded using the delirium evaluation scale on 1d,2d and 3d postoperatively.The incidence of acute myocardial injury and acute renal injury,POD,use of vasoactive drugs,fluid infusion,urine output,length of hospital stay,and mortality in hospital were recorded.Results: 1.General information of patients in the two groups(age,ASA classification,gender,Body mass index(BMI),weight,surgical type,preoperative complications)was compared,and the difference was not statistically significant(P > 0.05).2.The variation of SBP,DBP and MAP in group T was lower than that in group C,and the difference was statistically significant(P<0.05).However,the use of vasoactive drugs was significantly lower in group C than that in group T,and the difference was statistically significant(P<0.05).There was no statistically significant difference in fluid infusion and urine output between the two groups(P>0.05).3.Compared with the group C,the incidence of myocardial injury(6.3%)and the incidence of postoperative delirium(2.1%)in group T decreased,and the difference was statistically significant(P<0.05).There was no significant difference in postoperative kidney injury(2.1% VS 5.8%)between the two groups(P>0.05).The length of hospital stay(15.0±6.0 VS 17.5±10.1)was not statistically significant(P>0.05).No patients died in either group.Conclusion:Tight blood pressure management(controlling intraoperative MAP levels over 65 mm Hg)guided by TL-300 Continuous Non-invasive Arterial Pressure Monitoring can not only reduce blood pressure variability and hypotension,but also reduce the incidence of postoperative myocardial injury and POD. |
PDF Full Text Request