静脉降压药物对颈动脉内膜剥脱术患者围手术期血压的影响

Effect of intravenous antihypertensive drugs on blood pressure during perioperative period of carotid endarterectomy

目的探讨颈动脉内膜剥脱术(CEA)术中应用静脉降压药物对围手术期血压的影响。方法收集2017年1月至2019年12月于中国医学科学院北京协和医学院北京协和医院就诊的172例颈动脉狭窄合并高血压行CEA治疗患者的临床资料。根据术中静脉降压药物使用情况将68例术前血压控制不良患者分为单药组(n=35)和联合用药组(n=33),比较不同静脉降压药物对术中全身麻醉拔管前、术后第1天清晨血压的影响,分析CEA术后发生高血压的危险因素。结果单因素分析结果显示,双侧颈动脉狭窄、高脂血症、术前血压控制不良、术中全身麻醉拔管前血压控制不良均可能是CEA术后发生高血压的影响因素(P﹤0.05)。多因素分析结果显示,高脂血症、术前血压控制不良、术中全身麻醉拔管前血压控制不良均是CEA术后发生高血压的危险因素(P﹤0.05)。单药组患者组内术中全身麻醉拔管前血压比较,差异无统计学意义(P﹥0.05);使用硝酸甘油注射液的术后血压明显低于盐酸乌拉地尔注射液,差异有统计学意义(P=0.003)。联合用药组患者组内术中全身麻醉拔管前、术后血压比较,差异均无统计学意义(P﹥0.05)。结论CEA术前血压控制不良患者术中静脉降压药物单独与联合使用的降压效果相当,其中,术中单用硝酸甘油注射液后,患者的术后血压优于盐酸乌拉地尔注射液。

Objective To investigate the effect of intravenous antihypertensive drugs on blood pressure during perioperative period of carotid endarterectomy(CEA).Method The clinical data of 172 carotid artery stenosis patients with hypertension undergoing CEA in Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College from January 2017 to December 2019 were collected.According to the use of intraoperative antihypertensive drugs,the 68 inadequately controlled patients of preoperative pressure were divided into single drug group(n=35)and combined drug group(n=33).The effect of antihypertensive drugs on blood pressure before extubation under general anesthesia and the first morning after operation were compared,the risk factors for postoperative hypertension after CEA were analyzed.Result Univariate analysis showed that bilateral carotid artery stenosis,hyperlipidemia,poor preoperative blood pressure control or poor intraoperative blood pressure control before extubation under general anesthesia may be influencing factors for postoperative hypertension after CEA(P<0.05);multivariate analysis showed that hyperlipidemia,poor preoperative blood pressure control or poor intraoperative blood pressure control before extubation under general anesthesia were risk factors for postoperative hypertension after CEA(P<0.05).There were no statistically significant difference in blood pressure before extubation during general anesthesia in the single drug group patients(P>0.05);the postoperative blood pressure using nitroglycerin injection was significantly lower than that of urapidil hydrochloride injection,the difference was statistically significant(P=0.003).There was no significant difference intraoperative blood pressure before and after extubation under general anesthesia before and after extubation under general anesthesia in the combined medication group(P>0.05).Conclusion In patients with poor preoperative blood pressure control,intraoperative intravenous antihypertensive drugs used alone and in combination have the same antihypertensive effect.Among them,intraoperative nitroglycerin injection alone is superior to urapidil hydrochloride injection in postoperative blood pressure.