重度高血压伴心肌缺血行腹部急诊手术的麻醉处理  

Anesthetic treatment for acute abdomen surgery complicated with severe hypertension and myocardial ischemia

作　　者：白晓光[1] 董辉[1] 熊利泽[1] 侯立朝[1] 侯丽宏[1] 杨新雷 

机构地区：[1]第四军医大学西京医院麻醉科,陕西西安710033

出　　处：《第四军医大学学报》2000年第5期S090-S092,共3页Journal of the Fourth Military Medical University

摘　　要：目的　探讨高血压伴心肌缺血在全麻下行急诊腹部手术时应用佩尔地平、艾司洛尔及硝基甘油治疗的临床效果 .方法　上述患者 2 4例 ,于诱导插管前及术毕拔管前 ,静注艾司洛尔、佩尔地平 ,分别观察静注后至 30 min和 2 0 min时收缩压 ( SBP) ,舒张压 ( DBP) ,心率 ( HR)的变化 .术中观察静滴硝基甘油至 6 0 min及停药后至 30 m in,SBP,DBP,HR的变化 .结果　诱导插管前静注药物后 2 min,SBP,DBP,HR即显著下降 ,SBP于 2 5 min回升至原水平 ,HR于 30 min回升至原水平 .术毕拔管前静注药物后 ,SBP,DBP,HR显著下降 ,且维持至 2 0 min.术中静滴硝基甘油时 ,SBP,DBP显著下降 ,且维持至停药后 30 min,而 HR无显著改变 .结论　应用佩尔地平、艾司洛尔及硝基甘油能显著降低高血压及心率增快 ,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 。AIM To determine the clinical curative effect of perdipine, esmolol and nitroglycerin used in severe hypertension and myocardial ischemia complicated by acute abdomen surgery under general anesthesia. METHODS Twentyfour patients were observed. Before induction and intubation of anesthesia and extubation, esmolol and perdipine were infused and then the changes of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR) were observed from start to 20 or 30 minutes. During the operation, these changes were also observed from the start of venous dropping of nitroglycerin to 60 minutes and to 30 minutes after the stop of dropping nitroglycerin. RESULTS After infusion of esmolol and perdipine before induction and intubation of anesthesia, SBP, DBP and HR decreased from 2 to 20 minutes significantly, with SBP recovery in 25 minutes and HR recovery in 30 minutes. After infusion of those drugs before extubation, SBP, DBP and HR decreased significantly and were maintained for 20 minutes. During operation and continuously dropping nitroglycerin in veins, SBP and DBP decreased significantly from the start to 30 minutes, but HR didn't decrease. CONCLUSION Perdipine, esmolol and nitroglycerin can decrease hypertension and tachycardia significantly, maintain blood pressure and HR stability during induction and intubation of anesthesia and extubation, keep haemodynamics stable during operation and finally decrease the dosage of each drug and its side effects.

关 键 词：高血压 心肌缺血 腹部外科手术 麻醉 

分 类 号：R544.1[医药卫生—心血管疾病] R656[医药卫生—内科学]