胃肠道恶性肿瘤并发高血压的围手术期处理策略

Perioperative Treatment Strategies for Patients with Gastrointestinal Carcinoma Combining with Hypertension

目的探讨胃肠道恶性肿瘤合并高血压患者围手术期处理的有效方法。方法回顾性分析80例胃肠道恶性肿瘤合并高血压患者的围手术期处理措施及其效果。结果术前所有患者血压降至正常范围或较基础血压下降20%。3例患者术晨血压上升,给予静滴硝酸甘油降压后安全手术。术后为良好地控制血压,20例患者单用硝酸甘油,28例患者单用亚宁定,30例需要二者交替应用,2例出现顽固性高血压,静滴硝普钠后血压方可控制。并发心功能不全3例,其中2例抢救成功,1例并发肺炎发展为MODS死亡。结论围手术期采取综合措施可有效保障胃肠道恶性肿瘤合并高血压患者手术安全。

Objective To investigate the perioperative treatment methods for cases with gastrointestinal carcinoma combined with hypertension. Methods The clinic data of dealing with 80 cases with gastrointestinal malignant lesions combining hypertension were analyzed retrospectively. Results All cases＇ hypertensions were controlled or reduced 20% preoperatively. Three patients were intravenously dripped nitroglycerin for hypertension in operative morning. The postoperative blood pressure were con- trolled successfully with nitroglycerin （20 cases ）, urapidil hydrochlorid （28 cases） and alternation of nitroglycerin and urapidil hydrochlorid （30 cases）. There were 2 patients were intravenously dripped nitroprusside sodium for refractoriness hypertension. Three cases suffered postoperatively insufficiency of heart function, 2 patients were rescued successfully and one case died from MODS induced by pulmonary infection. Conclusion The operation was safe for patients with gastrointestinal carcinoma combined with hypertension dealt with the peri-operative composite methods.