高血压患者不同血管紧张素转换酶基因型与全麻围拔管期心血管反应  

Relationship between different angiotension converting enzyme genotypes and hemodynamic response to tracheal extubation in patients with essential hypertension

作　　者：王军[1] 胡毅平[1] 丁浩中[2] 曾因明[3] 朱晓红[4] 

机构地区：[1]无锡市人民医院麻醉科,214002 [2]无锡市手外科医院麻醉科 [3]徐州医学院江苏省麻醉医学研究所江苏省麻醉学重点实验室 [4]无锡市人民医院中心实验室

出　　处：《临床麻醉学杂志》2008年第2期126-128,共3页Journal of Clinical Anesthesiology

摘　　要：目的研究高血压患者不同血管紧张素转换酶(ACE)基因型与全麻围拔管期心血管反应的关系。方法105例有高血压病史、ASAⅡ或Ⅲ级的腹部手术患者,按RFLP-PCR法测定ACE基因型分为A、B、C三组,每组35例。其中,A、C组为DD型,B组为II型。三组均以相同麻醉药诱导及维持。C组拔管前经鼻腔滴入卡托普利混悬液25 mg。于术毕、拔管前、拔管后0、1.5、5、15 min记录SBP、DBP、HR和ECG,并计算心率收缩压乘积(RPP)。结果拔管前、拔管后0、1.5、5min A、B两组SBP、DBP、HR、RPP均较术毕显著升高(P<0.05或P<0.01),C组亦升高,但差异无统计学意义,A组较B、C组升高明显(P<0.05或P<0.01)。A组围拔管期心律失常明显多于B、C组(P<0.05)。结论DD型高血压患者具有较高ACE活性水平,围拔管期血流动力学变化明显,卡托普利对此有一定防治效应。Objective To investigate the relationship between different angiotension converting enzyme（ACE） genotype and hemodynamic response to tracheal extubation in the patients with essential hypertension（EH）. Methods One hundred and five adult patients with EH,ASA class Ⅱ or Ⅲ , undergoing abdominal surgery were divided into three groups according to ACE genotype detected by RFLP-PCR The patients in group A and C were DD genotype,those in group B were Ⅱ genotype. The patients in group C were treated with captopril（CAP）before extubation. Anesthesia in all patients were induced and maintained with the same anesthics. SBP, DBP, H R, ECG and RPP were recorded at the end of operation, just before extubation and at 0,1.5,5, and 15 min after extubation. Results Before extubation and at 0, 1.5, 5 min after extubation, SBP, HR and RPP increased markedly compared with those at the end of operation in group A,B （P〈0.01 or 0.05） ,which increased more significantly in group A than those in group B and C, No significant changes occurred in SBP,DBP, HR or RPP in group C. The incidence of cardiac arrhythmias in group A was higher than that in group B and C. Conclusion The EH patients with DD genotype gene have a higher activity of ACE, resulting in a strong hemodynarnic response to tracheal extubation ,on which CAP has a preventing and treating effect.

关 键 词：高血压 血管紧张素转换酶基因型 血流动力学 拔管期心血管反应 

分 类 号：R614.2[医药卫生—麻醉学]