Effect Of Preoperative Nocturnal Blood Pressure Pattern On Postoperative Complications In Elderly Patients Undergoing Laparoscopic Gastrointestinal Tumor Surgery

Objective Biological rhythms refers to a phenomenon in which all biological activity and behavior change periodically.It can be classified into a number of subclasses.The most closely related to humans is circadian rhythms,which is regulated by light for about 24 hours.The 24-hour blood pressure of normal and healthy people has physiological circadian rhythm changes,which mainly shows the arytenoid blood pressure pattern of increasing in the day and decreasing at night.However,the blood pressure rhythm of the elderly is often in a state of disorder,especially the elderly patients with hypertension,diabetes,chronic kidney disease.At present,many studies have confirmed that elevated blood pressure at night will lead to an increase in the incidence of cardiovascular events and patient mortality,and aggravate the injury of target organs.However,most of the current research objects were limited to patients with hypertension who visited the department of cardiovascular medicine and did not involve patients who planned to undergo elective surgery.This study intended to analyze the correlation between preoperative nocturnal blood pressure pattern and postoperative complications in elderly patients undergoing laparoscopic gastrointestinal tumor surgery,so as to prevent postoperative target organ injury in elderly patients and improve the quality of recovery.Method A total of 131 elderly patients who underwent laparoscopic gastrointestinal tumor surgery under general anesthesia in our hospital from September 2018 to September 2021 were selected according to the exclusion criteria to conduct a prospective observational cohort study.The 24 h ambulate blood pressure was monitored 1 day before surgery,and the patients were divided into groups according to the rate of nocturnal blood pressure reduction.The nocturnal blood pressure reduction rate≥0%was in the nocturnal blood pressure reduction group（group D,80 cases）.The decrease rate of blood pressure at night<0%was nocturnal hypertension group（group R,51 cases）.Preoperative general conditions,24-hour blood pressure parameters,intraoperative conditions,and postoperative complications of the two groups were statistically compared,and then regrouped according to the different complications.Statistically significant variables in the univariate analysis were incorporated into the multivariate Logistic regression model to analyze the influencing factors of postoperative complications.Finally,Kaplan-Meier survival curve was drawn to show the cumulative incidence of complications during hospitalization,and the influence of preoperative nocturnal hypertension on postoperative complications in elderly patients undergoing elective gastrointestinal tumor surgery was evaluated.Results（1）Compared with group D,the preoperative prevalence of diabetes and left ventricular mass index in group R were significantly increased（P<0.05）;（2）The mean nocturnal systolic blood pressure and diastolic blood pressure of R group were significantly increased（P<0.05）,but other blood pressure parameters had no significant differences;（3）There was no statistical difference in the mean arterial pressure between the two groups at each time point.Compared with T₀,the mean arterial pressure between the two groups was significantly decreased at T_1-6（P<0.05）.There was no significant difference in other intraoperative conditions between the two groups;（4）There were significant differences in the incidence of acute kidney injury and acute heart failure between group D and group R during postoperative hospitalization:the incidence of acute kidney injury and heart failure was 10%and 3.8%in group D,and29.4%and 13.7%in group R,respectively;The risk of event occurrence in group R was2.941 times and 3.660 times of that in group D;（5）Multivariate Logistic regression analysis showed that nocturnal hypertension was an independent risk factor for postoperative acute kidney injury.Multivariate Logistic regression model results for acute heart failure showed that for every 1 mm Hg increase in mean nocturnal diastolic blood pressure,the risk of postoperative heart failure was reduced by 11.4%;（6）Kaplan-Meier curve of acute kidney injury and acute heart failure showed that the cumulative incidence of events in group R was significantly higher than that in group D（P<0.05）.Conclusions Preoperative nocturnal hypertension is associated with postoperative complications in elderly patients undergoing elective laparoscopic gastrointestinal tumor surgery:preoperative nocturnal hypertension increases the incidence of postoperative acute kidney injury and heart failure,and nocturnal hypertension is an independent risk factor for postoperative acute kidney injury...