高血压病人行急症手术的麻醉体会

Experience of Anesthesia in Emergency for Hypertension Patient

目的 探讨高血压病人施急症手术的麻醉方法及有关注意事项。方法 术前 30min给予哌替啶5 0mg ,异丙嗪 2 5mg ,东莨菪碱 0 3mg肌注 ,采用硬膜外阻滞或气管插管全麻。如施硬膜外阻滞时不加去甲肾上腺素 ,严密观察血压下降程度 ,给乌拉地尔 1 0～ 1 5mg或硝酸甘油 1～ 3μg/ (kg·min)持续静点。 结果 在 6 8例中出现室性早搏 3例 ,心动过速 6例 ,其余无异常情况发生 ,术中血压平稳 ,麻醉效果良好 ,术后 4 8h死于脑疝 1例 ,余均痊愈出院。结论 高血压病人施急症手术时 ,血压下降不应低于基础血压 2 0 % ,采用相关药物 ,补充血容量 。

Objective To discuss the anesthesia methods and important items in emergency for hypertension patient. Methods The epidural or intubation anesthesia were performed after injection of dolantin 50mg, promethazine 25mg and scopolamine 0.3mg. the BP was observed when urapidil or nitroglycerin were given intravenously. Results There were 3 of 68 cases with ventricular premature beat and 6 tachycardia and all with smooth BP and good effect. One died of cerebral hernia after 48 h. Other were recovered. Conclusion During anesthesia for hypertension patient in emergency operation, BP decrease should be 20% less that normal BP and available drug and blood volume should be given.