Short-term effects of intravitreal injection of anti-vascular endothelial growth factor drug on blood pressure and heart rate in patients aged over 80 years / 中华老年医学杂志

ABSTRACT

Objective:To investigate the changes of blood pressure and heart rate in patients aged over 80 years undergoing intravitreal injection of anti-vascular endothelial growth factor(VEGF)drugs under topical anesthesia without anesthetic monitoring in ophthalmology surgery, and to analyze the potential risk for surgery-induced acute cardiovascular and cerebrovascular events.Methods:This was a prospective observational cohort study.A total of 100 patients(aged 80 to 95 years, 47 males and 53 females)included 85 cases of wet age-related macular degeneration, 14 cases of retinal vein occlusion with macular edema, and 1 case of diabetic macular edema.These patients received anti-VEGF drugs injection, with accumulated injections of 1 to 36 times per patient.Blood pressure and heart rate were measured at visit to a medical clinic(as baseline), before operation, 0 min and 30 min after operation.The operation anxiety and pain scores were investigated by questionnaires.Comparison of systolic blood pressure, diastolic blood pressure and heart rate among four different time points was performed by Wilcoxon symbol rank test.Results:At four different time points i. e.at the baseline, before injection, 0 min and 30 min after injection, systolic blood pressure, diastolic blood pressure and heart rate showed an important regularity.The median systolic blood pressure at the four time points was 130(120-140)mmHg(1 mmHg=0.133 kPa), 142(129-149)mmHg, 153(139-164)mmHg and 143(130-151)mmHg, with ranges of 100-160 mmHg, 106-176 mmHg, 118-197 mmHg and 115-187 mmHg, respectively.The median diastolic blood pressure at the four time points was 70(65-75)mmHg, 76(69-83)mmHg, 81(73-87)mmHg and 75(69~81)mmHg, with ranges of 45-90 mmHg, 55-98 mmHg, 58-99 mmHg and 50-93 mmHg, respectively.The median heart rate at the four time-points was 70(65-80)beats/min, 72.5(65-81)beats/min, 73(66-80)beats/min and 70(65-76)times/min, with ranges of 50-95 beats/min, 48-101 beats/min, 51-93 beats/min and 50-87 beats/min, respectively.Systolic blood pressure and diastolic blood pressure were significantly increased from preoperative time to 0 min and 30 min after operation( P<0.01). Compared to the baseline, heart rate was increased before operation( P<0.01)and was decreased at 30 minutes after operation( P<0.01). Conclusions:Blood pressure fluctuation may exceed the safe range with an obvious increase of systolic blood pressure during the current intravitreal injection of anti-VEGF drugs in the patients aged over 80 years.Systolic blood pressure rises significantly before operation and falls back after operation, but it may last till 30 minutes after operation.The range of heart rate change is relatively small.Perioperative management and monitoring measures should be strengthened to reduce the risk of acute cardiovascular and cerebrovascular events.