缬沙坦对高血压病人麻醉诱导时血压的影响

目的 :观察缬沙坦对麻醉诱导时血压的影响。方法 :30例运用缬沙坦治疗的高血压病人随机分为 2组 :对照组 (手术当天继续服用缬沙坦 ) ,试验组 (术前 1d停用缬沙坦 ) ,每组各为 15例。麻醉诱导药采用异丙酚 ,阿曲库铵 ,芬太尼。记录诱导前 5min至诱导后 2 5min各时段血压值的变化、低血压持续时间及应用血管活性药物的总量。结果 :对照组收缩压 (SBP)在诱导后 15 ,2 0 ,2 5min有显著下降 ,与试验组比较差异有显著或有非常显著的意义。对照组SBP在诱导后 5 ,15 ,2 0 ,2 5min有显著下降 ,与诱导前比较差异有显著或有非常显著的意义。对照组发生 1次以上低血压的人数为 15例 (试验组9例 ) ,低血压的持续时间延长为 9min±s 6min(试验组 4min± 3min) ,血管活性药物的应用对照组明显增加 ,其中麻黄碱 15mg± 9mg(试验组 10mg±8mg) ,去氧肾上腺素 5 0 μg± 80 μg(试验组为 0 ) ,差异均有显著或有非常显著的意义。术后随访无明显并发症。结论 :缬沙坦可增加高血压病人麻醉诱导时低血压的发生率 ,建议术前停止使用

Blood pressure effect of valsartan on hypertension patients during induction of anesthesia

AIM: To observe the hypotensive effect during induction of general anesthesia in hypertension patients continuously treated with valsartan. METHODS: Thirty patients continuously treated with valsartan for hypertension were randomly divided into two groups. Control group(n=15) continued to receive valsartan 1 h before anesthesia. Test group(n=15) discontinued to receive valsartan on the day before surgery. Induction of general anesthesia was carried with propofol 1.5 mg·kg -1, fentanyl 4 μg·kg -1 and atracurium 0.5 mg·kg -1. During the procedure, the anethesiologist was required to maintain systolic blood pressure and heart rate within 30% of baseline values using intravascular fluid administration and vasoconstrictors (e.g, ephedrine, phenylephrine). Blood pressure variables were recorded each 1 min, from 5 min before the induction of anesthesia 25 min after that. The number and duration of hypotension events were collected, and total doses of vasoactive drugs were noted in each group. RESULTS: Systolic blood pressure significantly decreased in control group at 15,20 and 25 min after induction of anesthesia compared with test groiup(P<0.05 or P< 0.01). Systolic blood pressure in control group significantly decreased at 5,15,20 and 25 min after induction of anesthesia compared with blood pressure at 5 min before the induction of anesthesia(P<0.05 or P<0.01). In control group, at least 1 episode of hypotension occurred in all patients(control group 15, test group 9,P<0.01), and a longer duration of an episode of hypotension occurred(control group 9 min±6 min, test group 4 min±3 min, P<0.01). The amount of ephedrine(control group 15 mg±9 mg, test group 10 mg±8 mg) and phenylephrine(control group 50 μg±80 μg, test group 0), required to restore SBP was significantly(P<0.05) higher in control group compared with two groups. No complication was found. CONCLUSION: Valsartan may inclease the hypotensive occurance rate in hypertension patients during induction of general anesthesia. Recommendations to discotinue the drug on the day before the surgery may be justified.