RISKS OF GENERAL-ANESTHESIA AND ELECTIVE OPERATION IN THE HYPERTENSIVE PATIENT
RISKS OF GENERAL-ANESTHESIA AND ELECTIVE OPERATION IN THE HYPERTENSIVE PATIENT
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DOI：
10.1097/00000542-197904000-00002
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发表时间：
1979-01-01
期刊：
影响因子：
8.8
通讯作者：
CALDERA, DL
中科院分区：
文献类型：
--
作者：
GOLDMAN, L;CALDERA, DL
为了确定全身麻醉和择期手术对有高血压病史的患者的风险，对一系列40岁以上患者的676例连续手术进行了研究。所有患者术前检查，术中监测和术后密切随访。术前血压值较高的患者术中绝对血压下降幅度较大，但严格控制高血压患者的平均术中收缩压最低值（100 . ±. 2例）与持续治疗的患者（97 . ±. 3 μ g）或未处理（98 . ±. 2、轻度至中度高血压。在3组患者中，术中肾上腺素能药物或液体挑战的需求（分别为20%、33%和27%）和围手术期高血压事件的发生率（分别为27%、25%和20%）无显著差异。对有高血压病史患者数据的多变量分析显示，术前院内舒张压和术前院内收缩压均与围手术期血压不稳定的3个指标中的任何一个独立相关，与心律失常、缺血或衰竭的发生或与术后肾衰竭无关。有效的术中管理可能比术前高血压控制更重要，可以减少轻中度高血压患者的临床显著血压不稳定性和心血管并发症。
To determine the risks of general anesthesia and elective surgical procedures in patients with histories of hypertension, 676 consecutive operations in a series of patients more than 40 yr old were studied. All patients were examined preoperatively, monitored intraoperatively and closely followed postoperatively. Patients with higher preoperative blood pressure values had larger absolute intraoperative blood pressure decreases but the mean intraoperative systolic pressure nadirs in patients with tightly-controlled hypertension (100 .+-. 2 torr) did not differ from those in patients with persistent treated (97 .+-. 3 torr) or untreated (98 .+-. 2 torr) mild to moderate hypertension. Among the 3 groups of patients, the needs for intraoperative adrenergic agents or fluid challenges (20, 33 and 27%, respectively) and the incidence of perioperative hypertensive events (27, 25 and 20%, respectively) were not significantly different. Multivariate analysis of data for the patients with histories of hypertension showed that neither the preoperative in-hospital diastolic nor preoperative in-hospital systolic blood pressure valves independently correlated with any of these 3 indices of perioperative blood pressure lability, with the development of cardiac arrhythmias, ischemia or failure, or with postoperative renal failure. Effective intraoperative management may be more important than preoperative hypertensive control in decreasing clinically significant blood pressure lability and cardiovascular complications in patients who have mild to moderate hypertension.