硬膜外阻滞对高血压患者血压的影响

目的:比较未经正规治疗的高血压患者中位和低位硬膜外阻滞时对血压的影响。方法:有明确的高血压病史的急诊中上腹部手术麻醉病例42例(Ⅰ组)和下腹部手术麻醉病例47例(Ⅱ组),采用硬膜外阻滞后,比较手术时间、局麻药总量、麻醉后动脉血压下降的幅度和时相。结果:(Ⅰ组)手术历时62.3±17.8min,局麻药总量为利多卡因387.0±31.2mg,(Ⅱ组)手术历时56.8±14.9min,利多卡因总量366.7±30.1mg,均无显著差异。Ⅰ组硬膜外麻醉前平均动脉压为123.6±13.2mmHg,麻醉后最低的平均动脉压为69.5±10.0mmHg,出现最低平均动脉压的中位时间为26.3min,Ⅱ组麻醉前的平均动脉压为117.3±15.7mmHg,麻醉后最低平均动脉压为71.0±7.4mmHg,出现最低平均动脉压的中位时间为21.3min。两组在硬膜外阻滞后平均动脉压下降幅度及下降时间方面无显著差异。结论:未经很好控制的高血压患者硬膜外阻滞后均可引起血压急骤下降,低位硬膜外阻滞与中高位阻滞引起的血压下降幅度和时相相似。

Effects of Epidural Block on Blood Pressure for Patients with Essential Hypertension

Objective:To compare the effects of epidural block on blood pressure(BP) for patients with uncontrolled essential hypertension. Methods: Patients with uncontrolled essential hypertension for emergency epigastric surgery (Gruoup I )and hypogastric surgery(GroupII )were anesthetized with epidural block,the duration of surgery,total dosage of local anesthetics,the onset time and amplitude of the decrease of BP were compared between the two groups. Results: Surgery duration of Group I and Group II were 62.3 +17. 8min and 117.3+15 . 7min, and total dosage of lidocaine were 387 .0 + 31.2 mg and 366.7 +30.1 mg, respectively. BP before and after epidural block of Group I were 123.6 +13.2 mmHg and 69.5+ 10.0mmHg while that of Group II were 117.3+ 15.7 mmHg and 71.0 +7.4 mmHg, respectively. The median onset time to lowest BP of Group I and Group II after anesthesia were 26.3 min and 21.3 min,respectively.There was no difference between the two groups.Conclusion:Patients with uncontrolled essential hypertension show abrupt decreasement of BP after epidural blook. No difference of the amplitude and onset time was obesrved between higher or lower epidural block.