老年高血压患者围术期动态血压和动态心电图变化的临床研究

Perioperative changes of ambulatory blood pressure and dynamic electrocardiogram in the elderly with hypertension

目的 应用动态血压 (ABP)和动态心电图 (DCG)监测 ,研究老年高血压患者围术期血压和心电图的变化趋势及血压调控对减少术后心脏并发症的意义。方法 2 4例择期上腹部手术老年高血压患者分两组 :研究组 (Ⅰ组 ) ,全麻复合硬膜外阻滞 ,围术期用抗高血压药调控血压 ;对照组(Ⅱ组 ) ,全麻 ,围术期无血压调控。监测 2 4hABP、DCG和心输出量 (CO)。结果 (1)术前 2 4h于ABP及血压负荷均高于正常 ,Ⅱ组较Ⅰ组增高显著。血压昼夜节律呈非勺型改变的发生率 ,Ⅰ组为37 6 8% ,Ⅱ组为 4 1 2 6 %。术后 ,Ⅱ组的各血压参数均显著升高 ,昼夜节律呈非勺型改变的发生率为89 79% ,显著大于Ⅰ组 (44 5 3% )。 (2 )心律失常的发生率 ,术前与术后以及组间均无显著差异。Ⅰ组术后心肌缺血的发生率 (4 17% )显著低于Ⅱ组 (2 0 83% )。结论 对老年高血压患者进行围术期血压调控 ,可以减轻应激反应 ,保持循环功能稳定 ,降低术后心肌缺血的发生率。

Objective To study the changes of blood pressure and ECG and the importance of blood pressure modulation in decreasing postoperative cardiaovascular complication in the elderly with hypertension.Methods Twenty elderly patients with hypertension, scheduled for elective upper abdominal surgery, were divided into two groups. The patients in group Ⅰ were anesthetized with general anesthesia combined with epidural block and treated with anti-hypertensive drugs perioperatively, and in group Ⅱ, with general anesthesia without perioperative antihypertensive treatment.Ambulatory blood prossure(ABP),dynamic ECG(DECG)and CO were monitored continuously before and after surgery respectively. Results (1)As compared with the baselines, the average 24 hour ABP and blood pressure load were increased significantly in two groups, which were significantly higher in group Ⅱ than those in group Ⅰ. The incidence of nondippers in day and night ABP was significantly lower in group Ⅰ(37.68%) than that in group Ⅱ(41.26%).The incidence of nondipper in group I (44.53%) was significantly lower than that in group Ⅱ (89.79%).(2)There were no significant differences in the incidence of arrhythmia before and after surgery between two groups. The incidence of myocardial ischemia in group Ⅰ (5%) was significantly lower than that in goups Ⅱ (30%) postoperatively.Conclusion To take the measures perioperatively to control blood pressure in the elderly patients with hypertension can attenuate stress responses, stabilize the cardiovascular function, and decrease the incidence of postoperative myocardial ischemia.