血流动力学监测在颅内动脉瘤围术期血压管理中的应用

目的:探讨血流动力学监测在颅内动脉瘤围术期血压管理中的应用方法及效果。方法:对30例高血压患者及30例健康受试者进行血流动力学监测,确认与血压升高相关的血流动力学指数。将50例颅内动脉瘤患者随机分为观察组和对照组各25例,对照组给予围术期常规血压管理,观察组在此基础上给予血流动力学监测,比较两组患者围术期血压情况。结果:观察组患者围术期血压低于对照组(P0.05)。结论:血流动力学监测可指导颅内动脉瘤患者的临床血压控制,降低并发症发生风险。     

对围手术期患者血压、心率的护理分析

由于围术期手术患者的心理变化、麻醉、手术的影响，可引发血液动力学改变，使心脏负荷增加极易合并高血压、心肌缺血，冠状动脉综合症（CoronaryarterySyndronCAS）、心律失常等，使围术期患者病死率增加。本文通过观察手术患者不同时点的变化，以期发现血压心率变化的规律。     

丙泊酚联合依托咪酯对老年高血压患者全麻气管插管期间血流动力学的影响

在全麻气管插管期间,老年高血压患者血管硬化、弹性差,麻醉诱导药物容易引起血流动力学变化,尤其在伴有其他心脑疾病时,围术期发生严重并发症和麻醉意外的可能性很大。因此,为了老年高血压患者麻醉诱导期的安全,在众多的麻醉药物中,寻求合理的麻醉药物搭配,减少气管插管时的应激反应,维持血流动力学的稳定,对老年高血压患者的生命安全有着非常重要的作用。     

老年髋部骨折合并高血压病60例围手术期的护理管理

目的探讨老年髋部骨折合并高血压围手术期的护理经验。方法分析60例患者围手术期诱发血压进一步升高的各种因素,有针对性有计划地进行护理干预。结果 60例患者都能较好地配合手术医师安全渡过手术期,围手术期血压控制稳定,无心血管系统并发症发生,术后肢体恢复良好。结论高度重视围手术期影响血压进一步升高的危险因素,及时、有效地控制血压是手术顺利进行、减少术后并发症、提高手术成功率的重要保证。     

腹腔镜胆囊手术中输注艾司洛尔对高血压患者血流动力学的影响

高血压是临床最常见的慢性病,也是心脑血管病最主要的危险因素,该类患者在行腹腔镜胆囊手术时风险I生很高,特别是在麻醉诱导、气腹以及手术结束拔管时,血压波动变化大,脑卒中、心肌梗死是主要并发症。如何减少高血压患者围手术期心脑血管不良事件的发生,保证术中患者安全,是麻醉医生的重大责任。本研究通过术中输注13受体阻滞剂艾司洛尔,观察其对高血压患者血流动力学的影响。     

围术期高血压合理用药

高血压病是一种全身性疾病，可伴有心、脑、肾等重要器官损害。围手术期高血压患者进行手术危险很大，如何合理应用降压药物使围手术期高血压患者能平稳降压，保持血流动力学稳定，最大限度地提高手术成功率，减少并发症的出现是本文所要探讨的。     

老年原发性高血压患者与左室舒张充盈指数的关系

目的探讨老年高血压患者的左室舒张功能,评价二尖瓣,肺静脉的血液动力学变化.方法应用彩色多普勒超声检测56例老年高血压患者及35例老年健康对照组左心舒张功能及血流动力学参数.结果老年高血压组左心舒张功能指标I期高血压二尖瓣E峰＜A峰,Ⅱ、Ⅲ期高血压患者肺静脉心房收缩期逆向PVEA速率高于对照组.结论存在显著血流动力学异常,主要表现为左室舒张功能减退,左房压增高,I期高血压患者舒张功能与二尖瓣血流参数有良好的相关关系,Ⅱ、Ⅲ期高血压与肺静脉瓣血流参数有良好的相关关系,能完整评价高血压左室舒张功能.     

老年脑梗死患者脑动脉血流动力学与血压变异性的相关性

目的分析老年脑梗死患者脑动脉血流动力学与血压变异性的相关性,探讨血压变异性对患者脑动脉血流动力学的影响。方法将2018年3月—2019年11月收治的老年脑梗死172例作为脑梗死组,将同期收治的非脑梗死169例作为对照组。检测两组脑动脉血流动力学参数,记录两组血压变化情况,计算血压变异系数;分析老年脑梗死患者脑动脉血流动力学参数与血压变异系数的相关性。结果脑梗死组收缩期峰值速度、舒张末期速度及平均血流速度均小于对照组(P<0.01);两组血管阻力指数比较差异无统计学意义(P>0.05)。脑梗死组收缩压变异系数及舒张压变异系数均大于对照组(P<0.01)。老年脑梗死患者脑动脉血流动力学参数与血压变异系数均呈正相关(P<0.01)。收缩压变异系数、舒张压变异系数均是老年脑梗死患者脑动脉血流动力学参数变化的影响因素(P<0.01)。结论老年脑梗死患者脑动脉血流动力学与血压变异性有一定相关性,血压变异性可能是老年脑梗死患者脑动脉血流动力学参数变化的影响因素,临床可通过早期持续监测老年脑梗死患者的血压水平,并积极采取相关措施,对改善患者脑动脉血流动力学意义重大。     

不同降压措施用于高血压患者麻醉的临床观察

近几年来，高血压患病人数日趋增加。高血压患者剧烈的血压波动如不及时处理，可导致患者在麻醉和手术中出现心、脑、肾等重要脏器严重并发症，因此，围手术期高血压的处理显得至关重要。现将我院围手术期高血压患者50例的麻醉处理讨论如下。     

全髋置换术中骨水泥对60例老年患者血流动力学的影响分析

全髋置换术是高龄老年患者多见手术,鉴于老年患者本身的病理生理改变,多系统器官的退行性改变及髋关节手术的特点,使得围术期风险增大.术中骨水泥的应用对血管影响较大,容易导致血流动力学的变化,尤其对老年患者影响更为剧烈.本文对我院骨科2005/2008年60例全髋置换术老年患者术中应用骨水泥对血流动力学的影响进行了观察,现总结如下.     

重视老年高血压的调控与管理

伴随我国人口老龄化进程加速,老年高血压患者的数量逐年增加。目前通常情况下,年龄≥65岁的高血压患者被定义为老年高血压。与中青年高血压患者相比,老年高血压患者的发病机制、临床表现具有特殊性,患者心脑血管事件显著增加。老年高血压多表现为单纯收缩期高血压、脉压增大、血压易波动、合并疾病多等特点,与年轻患者相比降压治疗的难度增加。老年高血压的治疗目的是保护靶器官、减少心脑血管事件,但老年人的降压获益与患者治疗耐受性以及降压治疗的潜在危害相关,在治疗时应选择个体化治疗方案并全面评估和密切监测患者情况,平稳降压,其降压目标可设为＜150/90 mm Hg(1 mm Hg=0.133 kPa)。     

Aging and hypertension

Aging is known to be a dominant risk factor in the progression of hypertension. Thus, accompanied by an increasing mean age of the population in developed countries, prevention and management of hypertension in the elderly is a task of pressing urgency. Age-associated blood pressure elevation is a result of the aging process in organ systems, which play a key role in the regulation of blood pressure. In addition, advanced aging of the cardiovascular system contributes to the presence of a varied phenotype in elderly hypertension, such as nocturnal hypertension and morning hypertension. Therefore, in order to detect and treat age-associated hypertension appropriately, it is important to assess ambulatory blood pressure monitoring throughout the 24-h period.     

Aging and hypertension

Aging is known to be a dominant risk factor in the progression of hypertension. Thus, accompanied by an increasing mean age of the population in developed countries, prevention and management of hypertension in the elderly is a task of pressing urgency. Age-associated blood pressure elevation is a result of the aging process in organ systems, which play a key role in the regulation of blood pressure. In addition, advanced aging of the cardiovascular system contributes to the presence of a varied phenotype in elderly hypertension, such as nocturnal hypertension and morning hypertension. Therefore, in order to detect and treat age-associated hypertension appropriately, it is important to assess ambulatory blood pressure monitoring throughout the 24-h period.     

高龄股骨颈骨折患者一例围术期的循证护理

目的探讨高龄股骨颈骨折患者人工股骨头置换术围术期的个性化护理措施。方法运用循证护理的方法,在查阅文献的基础上对一例89岁股骨颈骨折患者开展围术期的循证护理。结果患者围术期未出现肺部并发症、血栓及泌尿系感染,骶尾部压疮经治疗痊愈。结论高龄股骨颈骨折患者围术期应注意肺部并发症、血栓、泌尿系感染及压疮等的预防,循证护理的运用可取得良好的效果。     

Management of hypertension with diabetes mellitus in the elderly

The number of an elderly patient who has hypertension with diabetes mellitus has been increasing year by year since the life style of people has become Americanized in our country. Metabolic syndrome is characterized by hypertension, dyslipidemia, central adiposity and insulin resistance. It is recently recognized as the high risk for the macrovascular disease such as cerebral infarction and acute myocardial infarction. In diabetic patients, to prevent the life-threatening event or slow complications intensive blood pressure control is as efficacious as good glycemic control. The optimal blood pressure level to reduce hypertension-related morbidity and mortality in diabetic elderly has been proposed 130/80 mmHg in JSH 2004. The blood pressure level in the elderly should be lowered very slowly with careful monitoring of systemic ischemia. Early use of antihypertensive drug combinations is gaining favor. As the first step therapy would be recommended angiotensin receptor blocker, angiotensin-converting enzyme inhibitor and sustained release calcium channel blocker. Especially in the elderly, good control of life-style related diseases would be achieved through a team effort comprising the clinician, psychologist, nurse, pharmacologist, dietitian, other professionals and the patient's family. Comprehensive geriatric assessment can facilitate the maintenance of drug compliance for well control of blood pressure level.     

β2-MG、UACR及Cys-C对原发性老年高血压肾损伤的预测价值

目的分析β2-MG、UACR及Cys-C对原发性老年高血压肾损伤的预测价值研究。方法选取2017年1月至2020年1月本院接收的90例原发性老年高血压患者临床资料,为研究组,根据是否合并肾损伤分为两组,将合并肾损伤者设为A组(n=52)例,将未合并肾损伤者设为B组(n=38)例;同时选取64例同期健康体检人群作为对照组。对比不同人群β2-MG、UACR及Cys-C水平;采用多元Logistic回归分析影响原发性老年高血压合并肾损伤的独立危险因素;应用ROC曲线分析β2-MG、UACR及Cys-C对原发性老年高血压合并肾损伤的预测价值。结果研究组患者β2-MG、UACR及Cys-C水平高于对照组,差异有统计学意义(P<0.05);A组患者β2-MG、UACR及Cys-C水平高于B组,差异有统计学意义(P<0.05);通过Logistic回归模型分析影响原发性老年高血压合并肾损伤的相关因素,得出:收缩压、舒张压、β2-MG、UACR、Cys-C、血脂异常为影响原发性老年高血压合并肾损伤的单因素(P<0.05),进一步分析发现舒张压异常、收缩压异常、β2-MG、UACR、Cys-C异常升高为影响原发性老年高血压合并肾损伤的独立危险因素(P<0.05);β2-MG、UACR、Cys-C及三者联合约登指数分别为0.626、0.638、0.624、0.788;β2-MG、UACR、Cys-C及三者联合曲线下面积分别为0.699、0.821、0.712、0.923,各指标曲线下面积以联合检测最大。结论β2-MG、UACR及Cys-C水平异常是影响原发性老年高血压合并肾损伤的独立危险因素,联合指标检测对评估患者病情有重要价值。     

加速康复外科理念在老年患者行脾切除联合贲门周围血管离断术中的应用

目的 探讨加速康复外科(ERAS)在老年门静脉高压患者行脾切除联合贲门周围血管离断术围手术期应用的效果和意义.方法 回顾性分析2015年8月至2019年8月在南京医科大学附属淮安第一医院因肝硬化门静脉高压行脾切除联合贲门周围血管离断术患者的临床资料,挑选出年龄＞65岁的老年患者共62例.其中有32例患者采用加速康复理念...     

亚临床甲状腺功能减退对老年高血压患者动态血压的影响

目的探讨亚临床甲状腺功能减退(亚甲减)与老年高血压患者动态血压的关系。方法 233例老年高血压患者分为高血压合并亚甲减组35例(A组)及单纯高血压组198例(B组)。计算体质量指数,常规测定2组患者收缩期及舒张期血压、身高、体质量、空腹血糖、血肌酐、血尿酸、血脂水平、甲状腺功能及24h动态血压并分析相关指标。结果 A组舒张压、24h平均舒张压均高于B组(P<0.01,P<0.05);Logistic多元回归分析结果显示,随年龄增加舒张压水平呈下降趋势,随血清促甲状腺激素水平增高、吸烟史延长,舒张压水平呈上升趋势。结论舒张压控制不良的老年高血压患者应行甲状腺功能检查,有助于高血压病因的诊断。     

Diagnosis and management of labile blood pressure during acute cerebrovascular accidents and other hypertensive crises

It is estimated that with more than 40 million adults in the United States having uncontrolled hypertension, the risk of developing ischemic or hemorrhagic stroke in this population is significant. In addition, roughly 1 of 100 patients with essential hypertension will experience a hypertensive crisis during their lifetime, and these accelerated hypertensive emergencies and urgencies complicate more than 27% of all acute medical problems in patients presenting to emergency departments (EDs) in the United States. Arterial hypertension, a prominent feature of acute stroke syndrome, usually declines spontaneously within a few days, but its presence at hospital admission or its acute development during hospitalization is often associated with worsening stroke outcome and early mortality. Control of hypertension in patients with subarachnoid and intracerebral hemorrhage, both forms of acute stroke, is directed at maintaining adequate cerebral blood flow to minimize ischemic damage and control intracerebral pressure while reducing the risk of rebleeding and developing cerebrovasospasm. Inappropriate lowering of the blood pressure in acute stroke may increase neurologic damage. However, adequate blood flow around the central area of the acute ischemic stroke or penumbra may result in ischemic cells being salvaged. Clinicians must be mindful that accelerated hypertension is associated with other types of patients seen in the ED, such as perioperative patients and patients with traumatic head injuries.     

高龄患者腹部手术围手术期的血糖监测

目的 总结高龄患者围手术期的血糖监测变化规律.方法 回顾性总结近年来156例腹部外科手术患者术前术后的血糖变化.结果 手术当天及术后第1天血糖水平较术前明显升高.结论 高龄患者腹部手术围手术期的血糖监测非常关键,掌握血糖变化规律,合理正确使用胰岛素.使患者的血糖保持稳定,顺利渡过围手术期.