高血压患者脊柱手术俯卧位后发生低血压的研究进展

Research progress of hypotension after prone position in patients with hypertension during spinal surgery

在目前的临床麻醉工作中,全身麻醉下行俯卧位脊柱手术的患者合并高血压病的情况明显增多。俯卧位后因腹腔和胸腔受压,下腔静脉回流减少,心室顺应性下降,每搏输出量减少可导致低血压;高血压患者长期服用降压药物,使得自主神经功能抑制,血压调节能力受损,全身麻醉的交感抑制和血管扩张作用可进一步加重低血压。低血压使重要脏器的血流及灌注减少,引起相关并发症,延长患者的住院时间甚至增加死亡率。高血压患者多合并心、脑、肾等重要靶器官的损害,更不易耐受低血压的发生。发生低血压时可通过补液、减浅麻醉及使用升压药予以纠正。目标导向液体治疗及α_1肾上腺素能受体激动剂的应用为麻醉医生更好地维持术中血流动力学稳定,实现患者的快速康复提供了保障。本文就高血压患者脊柱手术俯卧位后发生低血压的原因、对机体的影响及预防和处理的方法进行综述。

In the current clinical anaesthesia work,the incidence of hypertensive disease has significantly increased in patients with general anesthesia underwent prostrate spine surgery.The inferior vena cava is reduced because of the abdominal and thoracic compression in the prone position,and the ventricular compliance is decreased which resulted in the decline of the SV that leading to the hypotension.Antihypertensive drugs which taken by the chronic hypertensive patients cause the autonomic nervous function inhibition and blood pressure regulation impaired,and the sympathetic inhibition and vascular dilatation of general anesthesia further aggravate the hypotension.Hypotension can reduce the blood flow and perfusion of important organs,cause related complications,prolong hospital lengths of stay and even increase mortality.Hypertensive patients are more likely to be organ damaged,and are less resistant to the occurrence of hypotension.When hypotension occurs,it can be corrected by using intravenous infusion and vasoactive agents,or decreasing the level of anesthesia.The application of goal-directed fluid therapy and α_1 adrenergic receptor agonist ensure the stability of hemodynamic during surgery and make the patient recover quickly.In this paper,the causes of hypotension occurred in patients with hypertensive during spine surgery are reviewed,as well as the effects on organism and how to prevent and treatment.