老年高血压危象的急诊抢救及其改进措施研究

目的探讨老年高血压危象的急救抢救方法与改进措施。方法选取2006年1月~2012年2月肇庆市第二人民医院急诊科抢救治疗的老年高血压危象患者130例为研究对象,对其临床资料进行回顾分析。其中2006年1月~2009年11月入院的患者65例为对照组,行常规未改进的急诊抢救;2009年12月~2012年2月入院的患者65例为观察组,行快速平稳降压、吸氧治疗、预防惊厥、防治脑水肿等改进抢救措施。统计改进前后急诊抢救的总有效率,比较改进后患者经抢救治疗前后的心率、血压、血钾、血糖、尿素氮、白细胞计数、谷丙转氨酶含量水平的差异。结果①观察组治疗总有效率为89.23%(58/65),对照组治疗总有效率为73.85%(48/65),差异有统计学意义(P<0.05)。②观察组治疗1 h、停止急诊救治后收缩压与舒张压均明显低于治疗前,差异均有统计学意义(P<0.05)。观察组治疗1 h、停止急诊救治后心率与治疗前比较,差异无统计学意义(P>0.05)。③观察组患者急诊抢救后血钾、血糖、尿素氮、白细胞计数、谷丙转氨酶含量水平与治疗前比较,差异无统计学意义(P>0.05)。结论老年高血压危象患者的急诊抢救应以快速平稳降压为原则,同时依据患者靶器官的损伤程度制定个体化的针对治疗,并积极给予吸氧治疗等改进措施,能显著提高治疗有效率,保障患者生命安全。

Research of emergency treatment and improvement for elderly patients with hypertensive crisis

Objective To analyze the crisis first aid treatment and improvement of elderly patients with hypertensive crisis. Methods 130 elderly patients with hypertensive crisis treated in the Second People＇s Hospital of Zhaoqing City from January 2006 to February 2012 were retrospectively analyzed in this study. 65 patients from January 2006 to November 2009 were chosen as control group, they were treated with conventional emergency rescue; 65 patients from December 2009 to February 2012 were selected as observation group, they were treated with rapid and smooth drop in blood pressure after admission; oxygen therapy was given before the emergency treatment; convulsions and brain edema were prevented. The total efficiency of the emergency rescue was analyzed before and after improving. The difference in levels of heart rate, blood pressure, serum potassium, glucose, urea nitrogen, white blood cell count and alanine aminotransferase were compared before and after improved emergency treatment. Results ①The total effective rate in observation group was 89.23 %（58/65）, the total effective rate in control group group was 73.85 %（48/65）, the difference was statistically significant（P 0.05）. ②Systolic blood pressure and diastolic blood pressure in observation group 1hour after treatment, after a full stop of emergency treatment were all lower than those before the treatment, the difference was statistically significant（P 0.05）. The difference of heart rate in observation group among 1 hour after treatment, after a full stop of emergency treatment and before the treatment was not statistically significant（P 0.05）. ③The difference of serum potassium, blood sugar, urea nitrogen, white blood cell count, glutamic-pyruvic transaminase level in observation group before and after the emergency treatment was not statistically significant（P 0.05）. Conclusion Providing rapid and smooth drop in blood pressure are the important treatment principles in emergency treatment for elderly patients with hypertensive crisis. Developing individualized treatment for patients based on the degree of target organ damage, giving oxygen therapy and other improvements can significantly improve the treatment efficiency and protect the safety of patients.