[Risk analysis of cardiovascular events in elderly hypertensive patients with different risk stratification during the perioperative period].

OBJECTIVE: To study the risks of cardiovascular events of elderly hypertensive patients with different risk stratification during the perioperative period.

METHODS: 126 elderly hypertensive patients without cardiac surgery were selected and divided into following 3 groups: group I (in danger), group II (high-risk), group III (very high-risk), each group with 42 cases. Control group was randomly selected 42 elderly patients without hypertension and other cardiovascular risk factors. Sevoflurane, Etomidate, Propofol, Cisatracurium Besilate for Injection, Fentanyl were used to induction and maintenance of anesthesia. Patients' cardiac index (CI), cardiac output (CO), stroke volume (SV), systemic vascular resistance (SVR), peak velocity (Vpk), heart rate (HR), mean arterial pressure (MAP) were monitored by ultrasonic cardiac output monitor (ultrasonic cardiac output monitor, USCOM). Pre- and post-operative myocardial ischemia and arrhythmia were monitored by dynamic electrocardiogram (dynamic electrocardiography, DCG).

RESULTS: Incidence myocardial（9.5%, 31.0%, 40.5%), ischemia frequency [(10.4 ± 1.7) time, 13.3 ± 1.9) time, 17.4 ± 2.3) time], ischemic time [(116.4 ± 9.7) min, (174.3 ± 19.8) min, (212.4 ± 20.5) min] and arrhythmias incidence (28.6%, 52.4%, 92.9%) were specially more significant for group I, group II and group III patients within the postoperative 24 hours (P < 0.05). Comparison between group I, group II and group III each other, myocardial ischemia incidence (11.9%, 21.4%, 31.0%), ischemia frequency [(9.5 ± 1.5) time, (11.6 ± 2.0) time, (15.0 ± 2.2) time], ischemic time [(98.5 ± 9.4) min, (158.3 ± 16.7) min, (198.0 ± 18.1) min] and arrhythmias incidence (16.7%, 45.2%, 81.0%) gradually increased for 3 groups within the postoperative 48 hours (P < 0.05).

CONCLUSION: Risk of cardiovascular events significantly increases for elderly patients with cardiovascular high-risk factors in the perioperation period, and especially cardiovascular function is inhibited most obviously in the general anesthesia intubation immediately before and after 24 hours and is prone to cardiovascular events, such as myocardial ischemia and arrhythmia.