老年高血压患者围术期静脉使用乌拉地尔和硝普钠降压疗效对比研究

Comparison study of urapidil and sodium nitroprusside on perioperative management of abdominal surgery in the aged patients with essential hypertension

目的观察乌拉地尔(URA)在老年高血压患者腹部手术围手术期控制血压的效果和优点以及它对心血管系统效应的影响。方法将病例随机分成两组,乌拉地尔组(n=127)和硝普钠组(n=127)和对比观察两组在围术期心率、血压(MAP)的变化。结果乌拉地尔组降压开始后HR逐渐减慢,降压均维持在正常范围(P>0.05);硝普钠组降压开始后HR多有明显增快,与乌拉地尔组比较有显著性差异(P<0.05)。结论老年高血压患者行腹部外科手术治疗前应使血压控制在正常高值水平,术中发生血压波动应尽早处理,术后密切观察,防止心衰及心肌梗塞等并发症发生,静脉应用盐酸乌拉地尔降压疗效肯定,其控制血压较硝普钠平稳,效果明显优越,其特点为降压过程缓和,心率变化小,降压后不反跳;使用安全,副作用少,可作为高血压围术期的首选药物。

Objective To study the perioperative management of abdomidal surgery in aged patients, to compare study of Urapidil and Sodium Nitroprusside on decresing hypertension perioperative. Methods From January 2002 to December 2008, the perioperative clinical data of 254 oldly patients with hypertension and undergoing abdomensurgery in our hospital were divided randomizedly into two groups： Urapidil and Sodium Nitroprusside groups, physical examination beforeoperation; pretection of the functions of the main organs; treatment of other accompanied chronic diseases or complicated syndrome and giving nutrition supports. Blood pressure and heart rate were measured before and after 30min,stoped treatment 30min and admitted ICU. Results The incidences of perioperative hypertensive events were not significantly different. Before and after treatment, the values of BP and HR did significantly decreased between Urapidil and Sodium Nitroprusside groups; HR were higher in Sodium Nitroprusside group, but they did not change in Urapidil group. Conclusion It is important to strengthen perioperative management for decreasing complications and improving curative effect in the aged patients who under went various abdominal surgery. Unmarkedly decrease blood pressure and heart rate. The effect of both drugs were similar in improvement of systolic and diastolic pressurein the patients with hypertension and with rare side effects.