高血压患者行腹部急诊手术的麻醉处理

Anesthesia of patients with hypertension undergoing abdominal emergency operation

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20min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60min及停药后至30min，SBP、DBP、HR的变化。结果：诱导插管前静注药物后2min，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20min。术中泵注硝酸甘油时，SBP、DBP显著下降，且维持至停药后30min，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。

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）, diastolic 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 till 60 minutes and till 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 till 20 minutes significantly. During the period, 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： Combined application of urapidil and nitroglycerin can effectively control the blood pressure, maintain HR stability during induction and intubation of anesthesia and extubation, and keep stable haemodynamics during the operation.