围术期高血压的麻醉选择及管理
7血压过高的防治
高血压病人血压较麻醉前升高4.0kPa(30mmHg),应视为血压过高。血压过高首要危害是心肌耗氧和供氧失衡，严重时可导致心肌梗塞、急性左心衰、脑出血、夹层动脉瘤破裂等。首先应针对病因采取相应的措施，如加深麻醉或给予麻醉性镇痛药以消除疼痛反应，解除呼吸道梗阻，改善通气，以纠正低氧血症和高二氧化碳血症，对充盈的膀胱导尿等。如果措施无效，则须用药物控制血压，如乌拉地尔0.5～1.0mg/kg,尼卡地平0.2mg/kg,或艾司洛尔2mg/kg静脉滴注等。同时应密切监测心电图，注意有无心肌缺血。
参考文献
[1] 刘俊杰，赵俊，等.高血压病人的麻醉[M].现代麻醉学.第二版.北京：人民卫生出版社，1996，864-865.
[2] 钱燕宁.手术应激反应的新概念-神经免疫内分泌学说[J].国外医学?麻醉学与复苏分册，1995，16:193-195.
[3] Ingelmo PM, Ferri F, Fumagalli R. Interactions between general and regional anesthesia [J]. Minerva Anestesiol, 2006, 72 (6): 437-445.
[4] 马汉祥,马妮娜，张宁,等.椎管内阻滞镇痛作用的研究进展[J].国际麻醉学与复苏杂志，2010, 31(5): 466-469.
[5] Hanxiang Ma, Doi K, Nikai T, et al. Sedation Depends on the Level of Sensor Block Induced by Intrathecal Bupivacaine in Rats[J]. ASA, 2007, A 146.
[6] 项燕，祝胜美，许爱军，等.罗哌卡因硬膜外阻滞对异丙酚镇静催眠作用影响[J].中华麻醉学杂志.2004，24(5)：385-386.
[7] 赵国庆，王显春.不同麻醉方法对高血压病人围手术期血浆中4种神经肽的影响[J].临床麻醉学杂志，2003，1:11-13.
[8] 张秉钧.高血压病人外科手术时的几个问题[J].中国实用外科杂志，2000，20:196-197.
[9] 江静，吴言涛.高血压病人腹部外科手术531例临床分析[J].中国实用外科杂志，2001，21:280-282.
[10] Eappen S, Kissin I. Effect of subarachnoid bupivacaine block on anesthetic requirements for thiopental in rats[J]. Anesthesiology, 1998, 88(4):1036-1042.
[11] De Luca G, Savonitto S, Greco C, et al. Cardiogenic shock developing in the coronary care unit in patients with ST-elevation myocardial infarction [J]. J Gardiovasc Med (Hagerstown), 2008,9(10):1023-1029.
[12] Herget-Rosenthal S, Saner F, ChawlaLS. Approach to Hemodynamic Shock and Vasopressors [J]. Clin J Am Soc Nephrol, 2008, 3(2): 546-553.
[13]Barragan Garcia R. Cardiogenic shock continues to be the most serious complication of the acute myocardial infarction[J]. Arch Cardiol Mex, 2006, 76 Suppl 2:S275-S278.
[14] Ebo DG, Fisher MM, Hagendorens MM, et al. Anaphylaxis during anaesthesia: diagnostic approach[J]. Allergy, 2007, 62(5):471-487.
[15] Cao Z, Gao Y, Tao G. Vasoplegic Syndrome During Liver Transplantation[J]. Anesth Analg, 2009,108 (6):1940-1943., http://www.100md.com(黄春苹)
高血压病人血压较麻醉前升高4.0kPa(30mmHg),应视为血压过高。血压过高首要危害是心肌耗氧和供氧失衡，严重时可导致心肌梗塞、急性左心衰、脑出血、夹层动脉瘤破裂等。首先应针对病因采取相应的措施，如加深麻醉或给予麻醉性镇痛药以消除疼痛反应，解除呼吸道梗阻，改善通气，以纠正低氧血症和高二氧化碳血症，对充盈的膀胱导尿等。如果措施无效，则须用药物控制血压，如乌拉地尔0.5～1.0mg/kg,尼卡地平0.2mg/kg,或艾司洛尔2mg/kg静脉滴注等。同时应密切监测心电图，注意有无心肌缺血。
参考文献
[1] 刘俊杰，赵俊，等.高血压病人的麻醉[M].现代麻醉学.第二版.北京：人民卫生出版社，1996，864-865.
[2] 钱燕宁.手术应激反应的新概念-神经免疫内分泌学说[J].国外医学?麻醉学与复苏分册，1995，16:193-195.
[3] Ingelmo PM, Ferri F, Fumagalli R. Interactions between general and regional anesthesia [J]. Minerva Anestesiol, 2006, 72 (6): 437-445.
[4] 马汉祥,马妮娜，张宁,等.椎管内阻滞镇痛作用的研究进展[J].国际麻醉学与复苏杂志，2010, 31(5): 466-469.
[5] Hanxiang Ma, Doi K, Nikai T, et al. Sedation Depends on the Level of Sensor Block Induced by Intrathecal Bupivacaine in Rats[J]. ASA, 2007, A 146.
[6] 项燕，祝胜美，许爱军，等.罗哌卡因硬膜外阻滞对异丙酚镇静催眠作用影响[J].中华麻醉学杂志.2004，24(5)：385-386.
[7] 赵国庆，王显春.不同麻醉方法对高血压病人围手术期血浆中4种神经肽的影响[J].临床麻醉学杂志，2003，1:11-13.
[8] 张秉钧.高血压病人外科手术时的几个问题[J].中国实用外科杂志，2000，20:196-197.
[9] 江静，吴言涛.高血压病人腹部外科手术531例临床分析[J].中国实用外科杂志，2001，21:280-282.
[10] Eappen S, Kissin I. Effect of subarachnoid bupivacaine block on anesthetic requirements for thiopental in rats[J]. Anesthesiology, 1998, 88(4):1036-1042.
[11] De Luca G, Savonitto S, Greco C, et al. Cardiogenic shock developing in the coronary care unit in patients with ST-elevation myocardial infarction [J]. J Gardiovasc Med (Hagerstown), 2008,9(10):1023-1029.
[12] Herget-Rosenthal S, Saner F, ChawlaLS. Approach to Hemodynamic Shock and Vasopressors [J]. Clin J Am Soc Nephrol, 2008, 3(2): 546-553.
[13]Barragan Garcia R. Cardiogenic shock continues to be the most serious complication of the acute myocardial infarction[J]. Arch Cardiol Mex, 2006, 76 Suppl 2:S275-S278.
[14] Ebo DG, Fisher MM, Hagendorens MM, et al. Anaphylaxis during anaesthesia: diagnostic approach[J]. Allergy, 2007, 62(5):471-487.
[15] Cao Z, Gao Y, Tao G. Vasoplegic Syndrome During Liver Transplantation[J]. Anesth Analg, 2009,108 (6):1940-1943., http://www.100md.com(黄春苹)