Objective: To investigate the effect of different blood pressure management schemes on the quality of postoperative anesthesia recovery in elderly patients undergoing long-term gynecological laparoscopic tumor surgery. Methods: A total of 57 patients who underwent gynecological tumor surgery in Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine from May to October 2022 were prospectively included. The patients were randomly divided into two groups: the precise blood pressure management group [group P, n=28, aged (69.9±3.6) years] and the control group [group C, n=29, aged (68.6±3.1) years]. Group P adopted a precise blood pressure management scheme, and systolic blood pressure (SBP) fluctuated within±10% of basal blood pressure during operation, while group C adopted a routine blood pressure management scheme, which maintained SBP fluctuation within±20% of basal blood pressure during operation, and SBP≥90 mmHg (1 mmHg=0.133 kPa). The main outcome measures were the quality of anesthesia recovery (QoR-40) scores of the two groups 24 hours after the operation. The secondary outcome measures included lactate clearance rate and blood glucose change 2 hours after the beginning of the operation and immediately after the operation, post anesthesia recovery score (PARS) and sedation-agitation scale (SAS) 5 min after extubation, intraoperative norepinephrine dosage, volume of fluid administered, blood loss and urine volume, creatinine clearance rate and urea nitrogen clearance rate 24 hours after the operation, anesthesia satisfaction score, length of hospital stay and hospitalization cost, etc. Results: The QoR-40 score of group P [M (Q1, Q3)] 24 hours after operation was 192 (190, 195), which was higher than that of group C [170 (163, 178)] (P<0.001). The lactate clearance rates 2 hours after the beginning of the operation and immediately after the operation in group P [M (Q1, Q3)] were 31.0% (14.9%, 43.3%) and 21.1% (3.1%, 38.2%), which were higher than those in group C [-12.5% (-43.1%, 11.8%) and -22.2% (-61.3%, -11.1%)] (both P<0.05). The changes in blood glucose 2 hours after the beginning of the operation and immediately after the operation in group P [M (Q1, Q3)] were [1.1 (0.9, 1.4) mmol/L and 1.4 (0.9, 1.9) mmol/L], which were higher than those in group C [0.2 (-0.2, 0.5) mmol/L and 0.2 (-0.2, 0.5) mmol/L] (both P<0.05). The intraoperative urine volume, PARS score and SAS score 5 min after extubation, and anesthesia satisfaction score in group P [M (Q1, Q3)] were 400 (300, 500) ml, 8 (8, 9), 4 (4, 4) and 8 (8, 9), respectively, which were higher than those in group C [200 (100, 300) ml, 7 (7, 8), 3 (3, 3) and 6 (6, 7), respectively] (all P<0.05). There were no statistically significant differences in norepinephrine dosage, volume of fluid administered, blood loss, creatinine clearance rate, urea nitrogen clearance rate, length of hospital stay and hospitalization cost between the two groups (all P>0.05). Conclusion: The precise blood pressure management scheme of maintaining SBP fluctuation within±10% of basal blood pressure in elderly patients undergoing long-time gynecological laparoscopic tumor surgery can significantly enhance the quality of postoperative anesthesia recovery, improve the patients' satisfaction, and facilitate the patients' postoperative rehabilitation.
目的： 探讨不同血压管理方案对老年长时间妇科腹腔镜肿瘤手术患者术后麻醉恢复质量的影响。 方法： 前瞻性纳入2022年5至10月浙江大学医学院附属杭州市第一人民医院行妇科肿瘤手术患者57例。采用随机数字表法将患者分为两组：（1）精准血压管理组（P组）：28例，年龄（69.9±3.6）岁；（2）对照组（C组）：29例，年龄（68.6±3.1）岁。P组采用精准血压管理方案，术中维持收缩压波动在基础血压的±10%以内；C组采用常规血压管理方案，术中维持收缩压波动在基础血压的±20%以内，且收缩压≥90 mmHg（1 mmHg=0.133 kPa）。主要观察指标为两组患者术后24 h的麻醉恢复质量（QoR-40）评分。次要观察指标包括两组患者手术开始2 h及手术结束后即刻乳酸清除率和血糖变化值，拔管后5 min时的麻醉后恢复评分（PARS）和镇静-躁动评分（SAS），术中去甲肾上腺素用量、输液量、出血量和尿量，术后24 h的肌酐清除率及尿素氮清除率，患者麻醉满意度评分、本次住院时间和住院费用等。 结果： P组患者术后24 h的QoR-40评分［M（Q1，Q3）］为192（190，195）分，高于C组的170（163，178）分（P<0.001）。P组患者手术开始2 h以及术后即刻的乳酸清除率［M（Q1，Q3）］分别为31.0%（14.9%，43.3%）、21.1%（3.1%，38.2%），均高于C组的-12.5%（-43.1%，11.8%）、-22.2%（-61.3%，-11.1%）（均P<0.05）。P组患者手术开始2 h以及术后即刻的血糖变化值［M（Q1，Q3）］分别为1.1（0.9，1.4）、1.4（0.9，1.9）mmol/L，均高于C组的0.2（-0.2，0.5）、0.2（-0.2，0.5）mmol/L（均P<0.05）。P组术中尿量、拔管后5 min时PARS评分和SAS评分以及患者麻醉满意度评分［M（Q1，Q3）］分别为400（300，500）ml、8（8，9）分、4（4，4）分和8（8，9）分，均高于C组的200（100，300）ml、7（7，8）分、3（3，3）分和6（6，7）分（均P<0.05）。两组患者术中去甲肾上腺素用量、输液量、出血量、术后24 h的肌酐清除率及尿素氮清除率、本次住院时间和住院费用等差异均无统计学意义（均P>0.05）。 结论： 老年长时间妇科腹腔镜肿瘤手术患者术中维持收缩压波动在基础血压±10%以内的精准血压管理方案可显著改善患者术后麻醉恢复质量，提高患者满意度，有利于术后康复。.