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骨科手术患者全身麻醉苏醒期高血压发生率的研究

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DOI:
作者:
徐怡琼，罗艳，于布为
Yiqiong Xu, Yan Luo, Buwei Yu
作者单位:
瑞金医院
Department of Anesthesia of Shanghai Ruijin Hospital
关键词:
高血压 骨科手术 全身麻醉 苏醒期
Hypertension, Orthopedics surgery, General anesthesia, Recovery period
摘要:
目的：观察接受全身麻醉的骨科手术患者在麻醉苏醒期时的血压波动情况，以了解全身麻醉下行骨科手术患者苏醒期高血压的发生率，进一步探寻苏醒期高血压发生的相关因素。方法：2011年5月至7月间在我院行全身麻醉下骨科手术的患者362例，分别记录入院的基础血压（BP0,SBP0/DBP0）和全身麻醉拔管后离开麻醉复苏室前的血压（BP1,SBP1/DBP1），并进行麻醉前后的组间比较。结果： 362名患者的BP0均值为126/76mmHg，BP1均值为137/85mmHg，SBP1较SBP0显著升高（P<0.001），DBP1较DBP0也显著升高（P<0.001）。其中172例（47.5%）患者出现了苏醒期高血压。患者苏醒期高血压的发生率与年龄（b=0.287，P<0.001）和基础收缩压SBP0（b=0.213，P<0.001）有关。在常见手术种类中，关节置换苏醒期高血压发生率最高，达55.2%。结论：全身麻醉的骨科患者苏醒期高血压的发生率为47.5%，年龄、基础血压水平和手术方式是引起苏醒期高血压的主要相关因素，而手术疼痛等级对苏醒期高血压的发生没有指导意义；老年、基础收缩压高和行关节置换手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 orthopedics patients before and after the surgery, and the occurrence of hypertension and the possible reasons. Methods: 362 patients undergoing elective orthopedics surgery with general anesthesia were included. 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: Mean BP0 was 126/76mmHg, while mean BP1 was 137/85. SBP1 was significantly higher than SBP0 (P<0.001), and DBP1 was also significangtly higher than DBP1(P<0.001). Of all the patients, 172 patients(47.5%) had hypertension during recovery. The occurrence of hypertension related with age（b=0.287，P<0.001） and systolic blood pressure before surgery（b=0.213，P<0.001）, and the rate was the highest in the joint replacement surgery(55.2%). Conclusions: The general occurrence rate of hypertension after orthopedic surgery was 47.5%. Age、 basal blood pressure and the method of the operation were the possible reasons for the hypertension after surgery, while pain stage of the surgery had no relationship with the hypertension. Those patients who were aged, with high sistolic pressure before surgery and undergoing joint replacement surgery should be noticed carefully during the perioperative period to find the hypertension as soon as possible, and to treate promptly to improve the outcomes.

 

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