本文關鍵詞： 高血壓 危險因素 圍術期 用藥方法 外科 預后　出處：《大連醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：高血壓病目前是全球性疾病，一般認為與生活節(jié)奏加快密切相關；經濟快速發(fā)展不健康生活方式所致我國高血壓病發(fā)病率很高。抽樣調查表明我國人群高血壓病知曉率為30.2%，治療率為24.7%，控制率為6.1%；高血壓病的并發(fā)癥較多且致死率高，并發(fā)癥中以腦卒中為主，腦卒中發(fā)病率約是冠心病的5倍。高血壓病引起心臟病占總死亡的23.1%，高血壓病引起的腦血管病占總死亡的21.3%。由此可見我國心腦血管病合并占總死亡的44.4%;心腦血管疾病引起的死亡率占首位。圍術期血壓屬于劇烈波動期，易出現(xiàn)血壓的大起大落，焦慮、麻醉誘導、手術操作、大量血液損傷等均會引起血壓波動，尤其是低血壓對高血壓患者影響更大，在于高血壓病患者平素器官灌注壓較高，血壓驟降會導致器官急性缺血；外科系統(tǒng)對高血壓病危害認識不足，導致圍術期血壓控制不佳�；谝陨锨闆r，探討合理的圍術期治療方案改善高血壓患者預后是臨床及科研的重要任務。 目的：分析外科患者高血壓病的相關危險因素如性別、年齡、體重指數(shù)、飲酒、教育程度、城鄉(xiāng)分布等情況及比較不同用藥方法對高血壓病患者預后的影響，干預方法包括用藥途徑及用藥時間，分析圍術期相關心腦血管事件發(fā)生情況；探討圍術期高血壓病有效干預方法，減少圍術期高血壓病相關心腦血管不良事件發(fā)生率。 方法：選取2013年6月至2013年8月大連醫(yī)科大學附屬第二醫(yī)院合并高血壓病外科患者150例，除外術前合并心肌梗死、糖尿病、腦卒中患者，盡可能排除干擾因素；分析患者年齡、性別、教育程度、城鄉(xiāng)分布、體重指數(shù)等一般情況，患者隨機分為3組，每組50例，，A組為單硝酸異山梨酯組，術中及術后出現(xiàn)高血壓癥狀靜點單硝酸異山梨酯注射液降壓，直到血壓降至正常水平；B組為利喜定組，術中及術后出現(xiàn)高血壓癥狀靜點烏拉地爾降壓直至血壓降至正常水平；C組為拜新同組，圍術期全程使用硝苯地平控釋片口服，包括手術當天。打印全部患者血壓趨勢圖，重點記錄重要時間點血壓值及記錄各組血壓最高值及最低值；統(tǒng)計圍術期各組低血壓發(fā)生幾率及高血壓相關心腦血管不良事件例數(shù)，包括術后術區(qū)及切口出血、術后認知異常、術后腎功異常、圍術期心肌梗死、腦卒中例數(shù)，統(tǒng)計有無顯著差異。 結果：圍術期發(fā)生低血壓幾率A組最大，血壓波動范圍A組最大，C組最��；A組不良事件16例，B組12例，C組5例，C組顯著低于其他組。 結論：危險因素中年齡因素對高血壓病患病率影響最大；圍術期全程使用降壓藥有更好的臨床獲益；外科患者圍術期使用規(guī)律口服藥更為理想。
[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.
【學位授予單位】：大連醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R544.1

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