术前夜间血压与结肠癌患者腹腔镜微创全结肠系膜切除术后发生并发症的关系

Study on the relationship between preoperative nighttime blood pressure and postoperative complications in patients undergoing laparoscopic minimally invasive total mesenterectomy for colon cancer

摘要:

目的 探讨术前夜间血压和结肠癌患者腹腔镜微创全结肠系膜切除术后发生并发症的关系。方法 选择2017年3月－2023年3月于该院行腹腔镜微创全结肠系膜切除术的174例结肠癌患者。将术前夜间血压下降率 ≥ 0%的患者作为下降组，例数为92例；将术前夜间血压下降率 < 0%的患者作为上升组，例数为82例。分别收集患者在入室时、手术开始即刻、手术开始至30 min后、手术开始至60 min后、手术开始至120 min后和手术完成时的平均动脉压（MAP）。记录患者住院期间术后并发症发生情况；采用多因素Logistic回归模型，分析结肠癌患者行腹腔镜微创全结肠系膜切除术后发生并发症的独立危险因素。结果 术前，下降组糖尿病发生率与左心室质量指数明显低于上升组（P < 0.05）；术前24 h动态血压参数中，两组患者术前夜间舒张压与夜间收缩压比较，差异有统计学意义（P < 0.05）；两组患者术中MAP各时间点比较，差异均无统计学意义（P > 0.05）；两组患者手术开始后各时间点MAP明显低于入室时（P < 0.05）；下降组术后住院时急性肾损伤的发生率为10.87%，明显低于升高组的31.71%（P < 0.05）；多因素Logistic回归分析结果显示，术前夜间血压上升为结肠癌患者行腹腔镜微创全结肠系膜切除术后发生急性肾损伤的独立危险因素（P < 0.05）。结论 术前夜间血压上升为结肠癌患者行腹腔镜微创全结肠系膜切除术后发生急性肾损伤的独立危险因素。

Abstract:

Objective To investigate the relationship between preoperative night blood pressure and postoperative complications of laparoscopic minimally invasive total mesenterectomy in patients with colon cancer.Methods The subjects were 174 patients who underwent laparoscopic minimally invasive mesenterectomy from March 2017 to March 2023. According to the preoperative night blood pressure drop rate, colon cancer patients were divided into two groups: the patients with a drop rate ≥ 0% of the preoperative night blood pressure were used as the declining group, and the number of cases was 92; The patients with drop rate < 0% in blood pressure at night before surgery was included in the rising group, and the number of cases was 82. The MAP of laparoscopic total mesenterectomy for colon cancer were collected at the time of admission, immediately after the start of surgery, from the beginning of the surgery to 30 minutes later, from the beginning of the surgery to 60 minutes later, from the beginning of the surgery to 120 minutes later, and at the completion of surgery. The incidence of postoperative complications during hospitalization in patients undergoing laparoscopic minimally invasive total mesenterectomy for colon cancer was recorded; Multivariate Logistic regression analysis was used to analyze the independent risk factors for complications after laparoscopic minimally invasive total mesenterectomy in patients with colon cancer.Results Before surgery, the incidence of diabetes and left ventricular mass index in the declining group were significantly lower than those in the rising group (P < 0.05). Among all the preoperative 24-hour ambulatory blood pressure parameters in the two groups, only the difference between preoperative night diastolic blood pressure and preoperative night systolic blood pressure were statistically significant (P < 0.05), and there was no significant difference in MAP between the two groups at different time points during surgery (P > 0.05). At each time after surgery, the MAP of the two groups was significantly lower than that at the time of admission (P < 0.05). The incidence of acute kidney injury in the declining group was 10.87%, which was significantly lower than that in the rising group 31.71% (P < 0.05). The results of multivariate Logistic regression analysis showed that the increase in blood pressure at night before surgery was an independent risk factor for acute kidney injury after laparoscopic minilally invasive total mesenterectomy for colon cancer (P < 0.05).Conclusion Preoperative night blood pressure increase is an independent risk factor for acute kidney injury after laparoscopic minimally invasive total mesenterectomy for colon cancer.