高血压患者全麻苏醒期应用乌拉地尔降压时机的临床研究

目的 探讨高血压（HTN）患者全麻苏醒期应用乌拉地尔降压的最佳时机.方法 对2009年3月至2013年4月在我院就诊的90例HTN患者的临床资料进行回顾性分析,根据随机数字表分组,每组30例,A组于气管拔管前5 min,B组于血压开始上升即刻,C组于脑电双拼指数（BIS）达70即刻,分别给予乌拉地尔降压,比较三组患者的心率（HR）、平均动脉压（MAP）波动趋势及心脑血管意外发生情况.结果 （1）组内比较：较之人手术室时（T.）,三组用药后各时间点的HR均明显高,而A组用药10 min（T5）后、B组用药后1 min（L）的MAP均明显升高,差异有统计学意义（P＜0.05）.组间比较：A组L后的MAP明显高于B组、C组,B组T3的MAP明显高于A组、C组,差异均有统计学意义（P＜0.05）,而各时间点HR组间比较差异均无统计学意义（P＞0.05）.（2）三组HTN患者全麻苏醒期心动过缓、心动过速、低血压、高血压等心脑血管意外事件发生情况组间比较,差异无统计学意义（P＞0.05）.结论 在HTN患者全麻苏醒期,于BIS达70即刻予以乌拉地尔,不仅降压效果确切,血流动力学也更平稳,值得深究推广.

Clinical research on urapidil decompression time in patients with hypertension in recovery period of general anesthesia

Objective To discuss the best time of urapidil decompression in patients with hypertension during recovery period of general anesthesia.Methods A retrospective analysis was carried out to study the clinical data of 90 cases with hypertension from March 2009 to April 2013 in our hospital.And the cases were divided into three groups according to random number table,30 cases in each group.Group A was given urapidil step-down 5 min before tracheal extubation,group B was given urapidil stepdown blood pressure began to rise immediately,group C was given urapidil step-down electrical double index （BIS） of 70 immediately,three groups were compared in the patient＇s heart rate （HR）,mean arterial pressure（MAP） fluctuation trend and heart cerebrovascular accident happening.Results （1） It did not show statistical significant differences between the three groups on general data of sex,age,weight,intraoperative blood loss and fluid volume （P ＞ 0.05）,which was comparable.（2） Then we compared with the To （in the operation room）,the HR of each time point in the three groups was significantly increased,the MAP in group A after administration of 10 min and in group B after administration of 1 min were significantly increased.Compared with those of group B and C,the MAP after T5 in group A was significantly increased.Compared with group A and group C,the MAP after T3 in group B was significantly increased.It showed statistical significant differences between them （P ＜ 0.05）.There was no statistical significant differences about HR between each group at each time point （P ＞ 0.05）.（3） It had no statistical significant differences about cardiovascular and cerebrovascular accident （bradycardia,sychnosphygmia,hypopiesia and hypertension） between the three groups （P ＞ 0.05）.Conclusion Giving urapidil at BIS rose to 70 immediately in recovery period of general anesthesia,can significantly reduce blood pressure,ensure more stable hemodynamics,and it is worthy of further promotion.