外科高血压患者危险因素及围术期药物干预效果的研究

发布时间：2018-02-24 07:02

本文关键词： 高血压危险因素围术期用药方法外科预后　出处：《大连医科大学》2014年硕士论文　论文类型：学位论文

【摘要】：高血压病目前是全球性疾病，一般认为与生活节奏加快密切相关；经济快速发展不健康生活方式所致我国高血压病发病率很高。抽样调查表明我国人群高血压病知晓率为30.2%，治疗率为24.7%，控制率为6.1%；高血压病的并发症较多且致死率高，并发症中以脑卒中为主，脑卒中发病率约是冠心病的5倍。高血压病引起心脏病占总死亡的23.1%，高血压病引起的脑血管病占总死亡的21.3%。由此可见我国心脑血管病合并占总死亡的44.4%;心脑血管疾病引起的死亡率占首位。围术期血压属于剧烈波动期，易出现血压的大起大落，焦虑、麻醉诱导、手术操作、大量血液损伤等均会引起血压波动，尤其是低血压对高血压患者影响更大，在于高血压病患者平素器官灌注压较高，血压骤降会导致器官急性缺血；外科系统对高血压病危害认识不足，导致围术期血压控制不佳。基于以上情况，探讨合理的围术期治疗方案改善高血压患者预后是临床及科研的重要任务。目的：分析外科患者高血压病的相关危险因素如性别、年龄、体重指数、饮酒、教育程度、城乡分布等情况及比较不同用药方法对高血压病患者预后的影响，干预方法包括用药途径及用药时间，分析围术期相关心脑血管事件发生情况；探讨围术期高血压病有效干预方法，减少围术期高血压病相关心脑血管不良事件发生率。方法：选取2013年6月至2013年8月大连医科大学附属第二医院合并高血压病外科患者150例，除外术前合并心肌梗死、糖尿病、脑卒中患者，尽可能排除干扰因素；分析患者年龄、性别、教育程度、城乡分布、体重指数等一般情况，患者随机分为3组，每组50例，，A组为单硝酸异山梨酯组，术中及术后出现高血压症状静点单硝酸异山梨酯注射液降压，直到血压降至正常水平；B组为利喜定组，术中及术后出现高血压症状静点乌拉地尔降压直至血压降至正常水平；C组为拜新同组，围术期全程使用硝苯地平控释片口服，包括手术当天。打印全部患者血压趋势图，重点记录重要时间点血压值及记录各组血压最高值及最低值；统计围术期各组低血压发生几率及高血压相关心脑血管不良事件例数，包括术后术区及切口出血、术后认知异常、术后肾功异常、围术期心肌梗死、脑卒中例数，统计有无显著差异。结果：围术期发生低血压几率A组最大，血压波动范围A组最大，C组最小；A组不良事件16例，B组12例，C组5例，C组显著低于其他组。结论：危险因素中年龄因素对高血压病患病率影响最大；围术期全程使用降压药有更好的临床获益；外科患者围术期使用规律口服药更为理想。
[Abstract]:Hypertension is a global disease, which is generally considered to be closely related to the accelerated pace of life. The incidence of hypertension caused by rapid economic development and unhealthy lifestyle in China is very high. The sample survey shows that the awareness rate of hypertension is 30.2, the treatment rate is 24.7and the control rate is 6.1. The main complications were stroke. The incidence of stroke is about 5 times higher than that of coronary heart disease. Heart disease caused by hypertension accounts for 23.1% of total death, cerebrovascular disease caused by hypertension accounts for 21.3% of total death. It can be seen that cardio-cerebrovascular disease combined with cerebrovascular disease accounts for 44.4% of total death in our country; cardiovascular and cerebrovascular diseases account for 44.4% of total death. Mortality due to disease is the highest. Perioperative blood pressure is highly volatile. High blood pressure fluctuations, anxiety, anesthesia induction, surgical procedures, and a large number of blood injuries can all cause blood pressure fluctuations, especially hypotension, which has a greater impact on hypertensive patients, because the normal organ perfusion pressure is higher in hypertensive patients. A sudden drop in blood pressure can lead to acute organ ischemia; the surgical system is insufficiently aware of the dangers of hypertension, leading to poor perioperative blood pressure control. It is an important task of clinical and scientific research to explore a reasonable perioperative treatment to improve the prognosis of hypertensive patients. Objective: to analyze the related risk factors of hypertension in surgical patients such as sex, age, body mass index, alcohol consumption, education level, urban and rural distribution, and to compare the influence of different medication methods on the prognosis of hypertensive patients. The methods of intervention included the ways and time of medication, the analysis of the occurrence of perioperative cardiovascular and cerebrovascular events, the effective intervention methods of perioperative hypertension, and the reduction of incidence of adverse cardiovascular and cerebrovascular events in perioperative hypertension. Methods: from June 2013 to August 2013, 150 patients with hypertension were selected from the second affiliated Hospital of Dalian Medical University, with the exception of patients with myocardial infarction, diabetes and stroke before operation. Interference factors were excluded as far as possible. Age, sex, education level, urban and rural distribution, body mass index were analyzed. The patients were randomly divided into 3 groups, 50 patients in each group were isosorbide mononitrate group. Hypertension symptoms occurred during and after operation. Isosorbide mononitrate injection lowered blood pressure until the blood pressure dropped to normal level. Symptoms of hypertension occurred during and after operation. Urapidil lowered blood pressure until normal level. Group C was treated with nifedipine controlled-release tablets during the perioperative period, including the day of operation. The blood pressure trend map of all patients was printed. The important time point blood pressure value and the highest and lowest blood pressure value of each group were recorded, the incidence of hypotension in each group during perioperative period and the number of adverse cardiovascular and cerebrovascular events associated with hypertension were recorded, including postoperative operative area and incision hemorrhage, postoperative cognitive abnormality, There were significant differences in renal dysfunction, perioperative myocardial infarction and stroke. Results: the incidence of hypotension in group A was the highest in perioperative period, and the range of blood pressure fluctuation in group A, group A, group C, group A, group A, group A, group A, group B, group B, 12 cases, group C, group C, 5 cases, group C were significantly lower than those in other groups. Conclusion: among the risk factors, age has the greatest influence on the prevalence of hypertension; the use of antihypertensive drugs in the whole perioperative period is a better clinical benefit; the perioperative use of oral drugs is more ideal for surgical patients.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R544.1

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