A Study For The Relationship Between Arterial Vasculopathy And Perioperative Cardiovascular Complication

Object: To study the characteristics and risk factors of postoperative complications in patients (≥50 years) undergoing non-cardiovascular operations, and to investigate the perioperative changes of arterial endothelial function (the impact of surgery/anesthesia/pain on arterial endothelial function), and to evaluate the possibility of arterial endothelial function and carotid intima-media thickness (IMT) as surrogate atherosclerosis markers to predict the incidence of postoperative cardiovascular and cerebrovascular events.Methods:1 Retrospectively analyzed 1975 cases operated in the period from January, 2004 to June 2005.2 Perspectively studied the patients underwent general anesthesia and operation on abdominal region. The key parameters were: blood pressure,heart rate,pain visual analogue score (VAS),blood glucose,blood lipids,renal function,cortisol,endothelium-dependent dilation (EDD),endothelium-independent dilation (Nitroglycerin-induced dilation, NTG) and carotid IMT respectively measured at one day before operation(baseline),2 hours on recovery from general anesthesia,postoperative day 1 and day 7.Results:1 In retrospective study, there were 1121 postoperative complications, which increased with age. Postoperative analgesia ratio was 48.51%, and the incidence of arrhythmias and coronary artery disease in analgesic group was higher than non-analgesic group(P<0.001, P<0.01).2 In perspective study, SBP,DBP and HR were significantly higher at 2 hours on recovery from anesthesia than in other three periods. VAS at 2 hours on recovery from general anesthesia and postoperative day 1 were significantly higher compared with baseline and postoperative day 7(P<0.001, P<0.001, P<0.001, P<0.001). EDD decreased and IMT increased with age gradually(r=0.584, r=0.349). EDD at 2 hours on recovery from anesthesia was significantly lower than baseline and postoperative day 7 (P<0.001,P<0.001) ,△EDD% was -10.5% compared with baseline; and EDD at postoperative day 1 was also lower than baseline and postoperative day 7 (P<0.05,P<0.01),△EDD% was -7.4%; EDD at postoperative day 7 had recovered to baseline,△EDD% was 2.9% (P>0.05). There were no statistic difference between EDD at 2 hours on recovery from anesthesia and postoperative day 1, and between EDD at baseline and postoperative day 7. While NTG was stable throughout. Backward stepwise multivariate linear regression analysis indicated that EDD was related with age, VAS and blood pressure. The group with atherosclerosis risk factors was older (P=0.011) and male dominant (P<0.0001). Compared with baseline, EDD decreased much more in Risk factor group than in non-Risk factor group (P>0.05), both groups had EDD improved significantly at postoperative day 7 and△EDD% had significant difference(P<0.05). At 2 hours on recovery from anesthesia and postoperative day 1, VAS had significant difference between endoscopic surgery group and open abdominal surgery group (P = 0.038,P = 0.040); EDD was lower and△EDD% was more in open abdominal surgery group than in endoscopic surgery group, although the statistical significance was marginal.Conclusion: Postoperative cardiovascular events of patients (particularly in the elderly) are common, increasing with age. Effective analgesia may reduce complication. Arterial endothelial function significantly decreases in the early postoperative period, but recovers in one week, implicating risk of postoperative cardiovascular complications. Perioperative arterial endothelial function in atherosclerosis Risk factor group was similar to that in non-Risk factor group, but recovered slowly. Endoscopic surgery cause less pain, slightly less impact on postoperative arterial endothelial function than open abdominal surgery.