骨科手术患者全身麻醉苏醒期高血压的发生情况

Hypertension during recovery in patients undergoing orthopedic surgery under general anesthesia

目的通过观察于全身麻醉下行骨科手术的患者麻醉苏醒期的血压波动情况,了解此类患者全身麻醉苏醒期高血压的发生率,以进一步探讨苏醒期高血压发生的相关因素。方法 2011年5—7月在上海交通大学医学院附属瑞金医院于全身麻醉下行骨科手术的患者362例,记录所有患者入院时的基础血压(基础收缩压、基础舒张压)和全身麻醉拔除气管导管后离开麻醉复苏室前苏醒期的血压(苏醒期收缩压、苏醒期舒张压),并进行比较。结果 >35岁且<65岁及≥65岁组患者的基础血压、苏醒期血压均显著高于≤35岁组(P值均<0.05),≥65岁组患者的基础收缩压、苏醒期血压均显著高于>35岁且<65岁组(P值均<0.05),各年龄组患者的苏醒期血压均显著高于同组的基础血压(P值均<0.01)。≤35岁、>35岁且<65岁、≥65岁组的高血压发生率分别为20.3%(12/59)、49.0%(98/200)、60.2%(62/103),3组间的差异有统计学意义(P<0.01)。重度疼痛手术组的苏醒期收缩压显著高于中度疼痛手术组(P<0.05),重度疼痛手术组的基础血压、苏醒期血压均显著高于轻度疼痛手术组(P值均<0.05),各手术疼痛分级组的苏醒期血压均显著高于同组的基础血压(P值均<0.05)。行内固定植入术患者的基础舒张压及行脊柱手术患者的基础血压、苏醒期血压均显著低于行关节置换术患者(P值均<0.05)。行关节置换术患者的苏醒期高血压发生率为55.2%(48/87),显著高于行内固定植入术患者的38.7%(46/119)及行脊柱手术患者的47.4%(45/95,P值均<0.05)。苏醒期高血压的发生率与年龄(r=0.287)和基础收缩压(r=0.213)呈正相关(P值均<0.01)。苏醒期收缩压与年龄(r=0.322)、手术疼痛分级(r=0.178)呈正相关(P值均<0.01),与手术种类呈负相关(r=-0.174,P<0.01)。苏醒期舒张压与年龄(r=0.340)、手术疼痛分级(r=0.216)呈正相关(P值均<0.01),与手术种类呈负相关(r=-0.194,P<0.01)相关。结论老年、基础收缩压高和行关节置换术的患者是苏醒期高血压发生的高危人群,围术期有必要加强对这类患者的血压监测并及时进行抗高血压治疗,以改善预后。

Objective To observe the blood pressure fluctuation of patients before and after orthopedic surgery, and to investigate the incidence of hypertension during recovery and the possible reasons. Methods A total of 362 patients undergoing elective orthopedics surgery under general anesthesia were included in the present study during May to July 2011. The basal blood pressure （BP0, SBP0/DBP0） and the blood pressure before leaving PACU （BP1, SBP1/DBP1） were recorded and the differences between BP0 and BP1 were compared. Results The BP0 and BP1 of patients of 35--65 years and patients 65 years were significantly higher than those of patients 〈35 years （P〈0.05）; the SBP0 and BP1 of patients 965 years were significantly higher than those of patients of 35--65 years the BP1 values （〈35 years, 35 65 years, 〉65 years） were significantly higher than BP0 values in all the three groups （P〈O. 01 ）. The incidence rates of hypertension were 20. 3% （12/59）, 49. 0% （98/200）, and 60. 2% （62/103） in the 〈35 years, 35--65 years, 65 years groups, respectively, with significant difference found among the three groups （P〈0.01）. The SBP1 of patients in severe pain group was significantly higher than that of patients in moderate pain group （P〈0.05） ; the BP0 and BP1 values of patients in severe pain group were significantly higher than those in miid pain group （P〈O. 05）. The BP1 values were significantly higher than BP0 values within each pain group （ P〈O. 05）. The DBP0 of patients ininternal fixation implantation group, BP0 and BP1 of patients in spinal group were significantly lower than those of patients in joint replacement group （P〈0.05）. The hypertension rate of BP1 in joint replacement group was 55.2% （48/87）, significantly higher than those of patients in the internal fixation implantation （38.7%, 46/119） and spinal group （47.4 %, 45/95, P〈O. 05）. The hypertension rate of BP1 was correlated with age （ r = 0. 287, P〈0.01） andSBP0 （r=0.213,P〈0.01）. BP1 was correlated with age （r=0.332, P〈0.01）, pain degree （r=0.178, P〈O.01） and the operation types （r=0.174, P〈0.01） while DBP1 was correlated with age （r=0.340, P〈0.01）, pain degree （r=0.216, P〈0.01） and the operation types （r=-0.194, P〈0.01）. Conclusion Aging, high systolic pressure before surgery and undergoing joint replacement surgery are the risk factors of hypertension during recovery of orthopedic surgery, and more attention should given during the perioperative period and timely anti-hypertension therapy should be given to improve the outcomes.