The Incidence Of Myocardial Injury In Patients Undergoing Radical Gastric Cancer Surgery With Neoadjuvant Chemotherapy:A Prospective Observational Study

Objective:To observe the occurrence of myocardial injury and perioperative cardiovascular adverse events in patients undergoing radical gastric cancer surgery after neoadjuvant chemotherapy,in order to optimize perioperative anesthesia management strategies for such patients to improve patient prognosis.Methods:A total of 111 patients undergoing radical gastric cancer surgery under general anesthesia were enrolled.They received 3 to 4 cycles of neoadjuvant chemotherapy before surgery.The chemotherapy regimen was capecitabine combined with oxaliplatin,and surgery was performed 3 weeks after chemotherapy.The age of the patient is 18-80 years old,gender is not limited,ASA gradeⅠ-Ⅲ,BMI 18-30kg/m²,denies severe neurological,mental,respiratory,and cardiovascular system dysfunction,denies history of drug,alcohol dependence,and history of propofol allergy.After the patient enters the operating room,the peripheral venous access is opened,and sodium acetate Ringer injection 10ml·kg^-1·h^-1is infused,and the electrocardiogram（ECG）,heart rate（HR）,pulse oxygen saturation（SpO₂）and non-invasive are monitored routinely Vital signs such as blood pressure（NIBP）and bispectral index（BIS）.After the patient’s general condition is stable,the left radial artery is punctured and placed under local anesthesia and the invasive arterial pressure（IBP）is monitored,and the mostcare monitor is connected to monitor the stroke volume（SV）and peripheral vascular resistance（SVR）.Sufentanil citrate 0.2～0.4μg/kg,propofol medium/long-chain fat emulsion 1.5～2.0mg/kg and cis-atracurium 0.15mg/kg were injected intravenously in order to induce anesthesia to achieve satisfactory insertion After the tube condition,the tracheal tube was inserted into the tracheal tube to perform mechanical ventilation.The ventilation mode selects the pressure-controlled volume guarantee mode（PCV-VG）,the tidal volume（VT）is set to8 ml/kg,and the inspiratory-expiratory ratio（I:E）is 1:1.5.Adjust the respiratory rate（RR）to maintain the end-tidal carbon dioxide partial pressure(P_ETCO₂)at 35～45mm Hg（1 mm Hg=0.133 Kpa）.Under ultrasound guidance,bilateral rectus abdominis sheath block and right internal jugular central puncture catheterization were performed,central venous pressure（CVP）was monitored,and 4ml·kg^-1·h^-1sodium acetate ringer was infused after induction.For injection,if the SV decrease is greater than 10%,infuse 200ml of hydroxyethyl starch within 15 minutes and continue to observe for 1 min.If the SV decrease is still greater than 10%,observe the peripheral vascular resistance（SVR）.If the SVR is less than 800,then 4μg of norepinephrine was injected intravenously to maintain hemodynamic stability.Anesthesia is maintained by intravenous inhalation combined anesthesia,inhalation of2%～3%sevoflurane to maintain BIS value of 40～60,continuous intravenous pump injection of remifentanil 0.1～0.3μg·kg^-1·min^-1for analgesia,intraoperative basis Intermittent intravenous injection of cisatracurium to maintain muscle relaxation during the operation.When the peritoneum was sutured after the operation,the concentration of sevoflurane was gradually decreased,and the inhalation of sevoflurane was stopped when the skin was sutured.After the patient reached the indication of extubation,the tracheal intubation was removed,and the vital signs were stabilized and returned to the ward.During the operation,if the systolic blood pressure（SBP）<90mm Hg,intravenous injection of ephedrine 6mg;when SBP>160mm Hg,first increase the sevoflurane inhalation concentration appropriately,if it is invalid,intravenous injection of urapidil 12.5mg;HR<45 times/min Intravenous injection of atropine 0.3 mg;when HR>120 times/min,intravenous injection of esmolol 10 mg,and the occurrence of the above cardiovascular adverse events was recorded.Venous blood was drawn from patients before operation（T₀）,postoperative day 1（T₁）,postoperative day 2（T₂）,and postoperative day 3（T₃）to monitor serum cardiac troponin I,and record the operation The occurrence of major adverse cardiovascular events afterwards.Results:1.This study included 111 patients who underwent radical gastric cancer surgery after neoadjuvant chemotherapy.The incidence of postoperative myocardial injury was 24.3%,and the incidence of major cardiovascular adverse events was 2.7%.The main patients with postoperative myocardial injury were The incidence of cardiovascular adverse events was 11.1%;2.Among all patients,21 patients had a peak of troponin I on the first postoperative day,accounting for 18.9%of all patients;4 patients had a peak of troponin I on the second postoperative day,accounting for 3.6%of all patients;2 patients had a peak of troponin I on the 3rd postoperative day,accounting for 1.8%of all patients;2 patients had a continuous increase in troponin I,accounting for 1.8%of all patients;3.Among the patients with elevated troponin I,15 cases of sinus tachycardia occurred,with an incidence of 13.5%;3 cases of patients with acute coronary syndrome,an incidence of 2.7%;acute cerebral infarction occurred There was 1 case of pulmonary embolism,with an incidence of 0.9%;1 patient with pulmonary embolism,with an incidence of 0.9%;1 patient with postoperative myocardial injury,with an incidence of 3.7%4.The risk coefficients of postoperative myocardial injury and ASA classification,history of hypertension and operation time in patients undergoing radical gastric cancer surgery after neoadjuvant chemotherapy were 0.207,0.261,0.248,respectively.Conclusion:1.The incidence of myocardial injury in patients undergoing radical gastric cancer surgery after neoadjuvant chemotherapy was 24.3%,and the incidence of major cardiovascular adverse events in patients with postoperative myocardial injury was 11.1%.2.Postoperative myocardial injury in patients undergoing radical gastric cancer surgery after neoadjuvant chemotherapy is correlated with ASA classification,history of hypertension and operation time.