Effect Of Preoperative Systolic Blood Pressure Variability On Postoperative Delirium And Early Postoperative Cognitive Dysfunction In Elderly Patients Undergoing Radical Resection Of Gastrointestinal Tumors

Objective More and more elderly patients need gastrointestinal tumor surgery.Postoperative delirium and postoperative cognitive dysfunction are common complications in elderly patients after general anesthesia,which can seriously affect the prognosis and quality of life of elderly patients.Previous studies have pointed out the relationship between intraoperative blood pressure variability and cognitive function of elderly patients.this study intends to study the effect of preoperative systolic blood pressure variability on elderly patients,so as to provide reference for perioperative management of elderly patients undergoing gastrointestinal tumor surgery.in order to reduce the incidence of postoperative delirium and postoperative cognitive dysfunction.Methods 150 patients undergoing elective radical resection of gastrointestinal tumors in our hospital were selected according to the standard of nano-platoon.All patients’ blood pressure was monitored before operation,and the actual variability of preoperative systolic blood pressure was calculated.During the operation,the systolic blood pressure of the two groups fluctuated by 20% above and below the preoperative basic value.MMSE scale was used to evaluate the cognitive function and postoperative cognitive impairment before and 1 day,3 days and 7 days after operation,and CAM-ICU method was used to evaluate the occurrence of postoperative delirium.The patients were divided into normal group and postoperative delirium group according to the occurrence of postoperative delirium.Univariate analysis was used to compare the differences between the two groups.Binary logistic regression analysis was used to evaluate the high risk factors of postoperative delirium and to study the relationship between preoperative blood pressure variability and postoperative delirium.According to the occurrence of postoperative cognitive impairment,the patients were divided into normal group and postoperative cognitive impairment group.Univariate analysis was used to compare the differences between the two groups.Binary logistic regression analysis was used to evaluate the high risk factors of postoperative cognitive impairment and to study the relationship between preoperative blood pressure variability and postoperative cognitive impairment.Results Univariate analysis showed that female,ASA grade,high cardiac function grade,coronary heart disease,low preoperative MMSE score,preoperative anemia,intraoperative blood transfusion and high preoperative systolic blood pressure variability were risk factors for postoperative delirium.Binary logistic regression analysis showed that low preoperative MMSE score,intraoperative blood transfusion,to ICU and high systolic blood pressure variability were independent risk factors for postoperative delirium.Univariate analysis with or without postoperative cognitive impairment showed that female,coronary heart disease,low preoperative MMSE score,actual variability of preoperative systolic blood pressure and intraoperative blood transfusion were high risk factors for postoperative cognitive impairment.Logistic regression analysis showed that low preoperative MMSE score,intraoperative blood transfusion and high systolic blood pressure variability were independent risk factors for postoperative cognitive impairment.Spearson correlation analysis showed that systolic blood pressure variability was significantly correlated with postoperative delirium and postoperative cognitive dysfunction,respectively.Conclusion Preoperative systolic blood pressure variability may increase the incidence of postoperative delirium and postoperative cognitive impairment in elderly patients undergoing radical resection of gastrointestinal tumors.larger preoperative systolic blood pressure variability,intraoperative blood transfusion and lower preoperative MMSE score are independent risk factors for postoperative delirium in elderly patients undergoing radical resection of gastrointestinal tumors.Intraoperative blood transfusion,lower preoperative MMSE score and high systolic blood pressure variability were independent risk factors for postoperative cognitive impairment.