Association of Intravitreal Injections With Blood Pressure Increase The Following Excitement and Anxiety Response Under Intravitreal Injection Study
Association of Intravitreal Injections With Blood Pressure Increase The Following Excitement and Anxiety Response Under Intravitreal Injection Study
复制标题
DOI：
10.1001/jamaophthalmol.2018.4892
复制
发表时间：
2019-01-01
影响因子：
8.1
通讯作者：
Zinkernagel, Martin S.
中科院分区：
文献类型：
--
作者：
Berger, Vanessa;Munk, Marion R.;Zinkernagel, Martin S.
尽管抗血管内皮生长因子治疗（VEGF）的有效性毋庸置疑，但关于潜在的全身不良反应仍存在争议。除了抗VEGF药物的直接不良反应，其他因素与注射本身，如围手术期的血压波动，可能会导致adverse events. ObjectiveTo确定血压波动在玻璃体内injectives.DESIGN，SETTING，AND PARTICIPANTS前瞻性观察研究在三级转诊中心（眼科，大学医院伯尔尼，伯尔尼，瑞士）。招募了计划进行玻璃体内注射的连续性患者。分析2017年10月至2018年1月期间的数据。主要结果和指标玻璃体内注射前、中、后记录收缩压和舒张压、脉率和血氧饱和度。所有参与者都完成了焦虑问卷。多元回归分析被用来调查潜在的因素与血压上升，在injecting.Results201例（92名女性和109名男性）被纳入本研究，平均年龄为68岁（范围，18-93岁）。平均（SD）收缩压从基线150（20）mm Hg增加到准备程序后的162（24）mm Hg，注射期间增加到168（24）mm Hg（P < .001）。平均（SD）舒张压分别从78（14）mm Hg升高至83（37）mm Hg和83（16）mm Hg（P = .009）。平均（SD）脉搏频率从76（13）bpm增加到80（13）bpm（P = .005）。总共有23名患者（11%）的收缩压大于200 mm Hg。该亚组患者的平均（SD）围手术期收缩压从182（19）mm Hg升高至214（12）mm Hg，导致升高32（20）mm Hg（P < .001）。年龄和焦虑是下一个与收缩压risk.Conclusions和相关性玻璃体内注射过程与血压一过性升高。大多数增加发生在注射前的准备之后。这可能构成治疗期间心血管或脑血管并发症的风险因素，并且可能与此类事件的高风险患者和频繁注射的患者特别相关。未来的工作可能需要确定，在有心血管或脑血管事件风险的患者中，是否需要考虑围手术期血压监测或降压治疗。
IMPORTANCE Despite the unquestionable effectiveness of anti-vascular endothelial growth factor therapy (VEGF), there is ongoing controversy about potential systemic adverse effects. Besides the direct adverse effects of anti-VEGF agents, other factors associated with the injection itself, such as perioperative blood pressure fluctuations, may contribute to adverse events.OBJECTIVE To determine blood pressure fluctuations during intravitreal injections.DESIGN, SETTING, AND PARTICIPANTS Prospective observational study at a tertiary referral center (Department of Ophthalmology, University Hospital Bern, Bern, Switzerland). Consecutive patients scheduled for intravitreal injections were recruited. Data were analyzed between October 2017 and January 2018.MAIN OUTCOMES AND MEASURES Systolic and diastolic blood pressure, pulse rate, and oxygen saturation were recorded before, during, and after the intravitreal injection. An anxiety questionnaire was completed by all participants. Multivariate regression analysis was used to investigate potential factors associated with blood pressure rise during injections.RESULTS Two hundred one patients (92 women and 109 men) were included in this study, with a mean age of 68 years (range, 18-93 years). Mean (SD) systolic blood pressure increased from a baseline of 150 (20) mm Hg to 162 (24) mm Hg following the preparation procedure to 168 (24) mm Hg during the injection (P < .001). Mean (SD) diastolic blood pressure increased from 78 (14) mm Hg to 83 (37) mm Hg to 83 (16) mm Hg, respectively (P = .009). Mean (SD) pulse frequency increased from 76 (13) bpm to 80 (13) bpm (P = .005). In total, 23 patients (11%) had a systolic blood pressure greater than 200 mm Hg. This subgroup of patients had a mean (SD) perioperative systolic blood pressure increase from 182 (19) mm Hg to 214 (12) mm Hg, resulting in an increase of 32 (20) mm Hg (P < .001). Age and anxiety were to be next associated with systolic blood pressure rise.CONCLUSIONS AND RELEVANCE The intravitreal injection process is associated with a transient increase in blood pressure. Most of the increase occurs following the preparation before the injection itself. This may constitute a risk factor for cardiovascular or cerebrovascular complications during treatment and could be of particular relevance in patients at high risk for such events and those receiving frequent injections. Future work may be needed to determine whether, in patients at risk for cardiovascular or cerebrovascular events, perioperative blood pressure monitoring or antihypertensive therapy needs to be considered.