高血压患者行腹部急诊手术的麻醉处理.pdfVIP

海南医学院学报 2008，14(4) 420 Journd ofHainan Medical College 高血压患者行腹部急诊手术的麻醉处理 张成炬，马保新，李洪跃 (厦门大学附属中山医院麻醉科，福建厦门 361004) [摘要]目的：探讨联合应用盐酸乌拉地尔和硝酸甘油治疗中重度高血压患者行上腹部全身麻醉急诊手 术时控制血压的疗效和安全性。方法：ASA2~3级高血压患者25例，于诱导插管前及术毕拔管前，静注 盐酸乌拉地尔，分别观察静注后至20 min时收缩压(SBP)、舒张压(DBP)、心率(HR)的变化。术中观 察泵注硝酸甘油至60 min及停药后至30 min，SBP、DBP、HR的变化。结果：诱导插管前静注药物后 2 min，SBP、DBP即显著下降，HR无明显改变，术毕拔管前静注药物后，SBP、DBP，显著下降，且维持至 20 min。术中泵注硝酸甘油时，SBP、DBP显著下降，且维持至停药后30 min，而HR无显著改变。结论： 联合应用乌拉地尔及硝酸甘油能有效控制血压，维持全麻诱导、拔管时血压、心率的平稳，维持术中血流 动力学的稳定。 [关键词]高血压；药用制剂；麻醉；外科手术 [中图分类号]R614．2 1 [文献标识码]A [文章编号]1007—1237(2008)04-0420-03 Anesthesia of patients with hypertension undergoing abdominal emergency operation ZHANG Cheng~u，MA Bao—xin，LI Hong-yue (Department ofAnesthesiology，Zhongshan Hospital Affilated to Xiamen University Xiamen 361004，China) [ABSTRACT]Objective：To investigate the clinical effect and safety of combined application of urapidil and nitroglycerin in generally anesthetized abdominal emergency operation for patients with ASA2~3 hypertension． Methods：Twenty—five ASA2~3 hypertension patients were studred．Before induction and intubation of anesthesia and extubation，urapidil was injected intravenously and then the changes of systolic blood pressure(SBP)，dias— tolic blood pressure(DBP)，heart rate(HR)were observed from the start till 20 minutes after injection．During the operation，these changes were also observed from the start of intravenous injection of nitroglycerin tin 60 mi- nutes and tiu 30 minutes after injection of nitroglycerin．Results：After intravenous injection of urapidil before in— duction and intubation of anesthesia．SBP and DBP decreased from 2 tiU 20 minutes significantly．During the peri— od，no significant change was found in HR．During operation and the course of continuous intravenous injection of nitroglycerin，SBP and DBP but not HR decreased significantly from the start till 30 minutes．Conclusion：Com