术前使用β肾上腺素受体阻滞剂对于中老年患者如期手术的影响与研究
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摘要
目的术前使用β肾上腺素受体阻滞剂对于中老年患者如期手术的影响与研究。方法随机选取2017年1月～2018年1月我院进行手术患者200例,按随机数字表法分为两组。两组患者均在高血压病情稳定下择期进行非心脏手术,均进行常规术前干预,观察组根据患者术前心率情况给予倍他乐克。检测两组患者治疗前及手术后心肌肌钙蛋白T(cTnT)、氨基末端B型利钠肽前体(NT-proBNP),统计两组患者治疗前、术后1d的压力反射敏感度(BRS)及心率变异,统计两组患者手术时机,统计两组患者围术期心血管事件发生率,统计两组患者不良反应发生率。结果术后观察组cTnT、NT-proBNP水平低于对照组,差异有统计学意义(P <0.05);术后1d,观察组BRS、低频、高频值高于对照组,低频/高频值低于对照组,差异有统计学意义(P <0.05);观察组如期进行手术患者比例高于对照组,差异有统计学意义(P <0.05);观察组围术期心血管事件发生率低于对照组,差异有统计学意义(P <0.05);两组患者均未出现严重不良反应。结论β肾上腺素受体阻滞剂可通过阻滞肾上腺β受体从而降低患者血压,保证患者如期进行手术。
Objective To explore the effect and research of preoperative use of β-adrenergic receptor blocker on the scheduled surgery of middle-aged and elderly people. Methods 200 patients undergoing surgery in our hospital from January 2017 to January 2018 were randomly selected and divided into two groups according to the random number table method.Patients in two groups were given elective non-cardiac surgery under stable hypertension,and they were all given routine preoperative intervention.The observation group was given Betaloc according to the preoperative heart rate of patients.Cardiac troponin T(cTnT) and N-terminal pro-brain natriuretic peptide(NT-proBNP) were measured before and after operation in the two groups.The baroreflex sensitivity(BRS) was measured before operation and on 1 day after operation.The operation timing,incidence of perioperative cardiovascular events and incidence of adverse reactions of patients in two groups were recorded. Results The levels of cTnT and NT-proBNP after operation in observation group were lower than those in control group.The difference was statistically significant(P < 0.05).On 1 day after operation,BRS,low frequency and high frequency values in the observation group were higher than those in the control group,and the value of low frequency divided by high frequency was lower than that in control group.The difference was statistically significant(P< 0.05).The proportion of patients with surgery on schedule in observation group was higher than that in control group.The difference was statistically significant(P < 0.05).The incidence rate of perioperative cardiovascular events in observation group was lower than that in control group.The difference was statistically significant(P < 0.05).There was no serious adverse reaction in patients of the two groups. Conclusion β-adrenergic receptor blocker can lower the blood pressure and ensure that patients can undergo surgery as scheduled by blocking the adrenal β receptor.
Objective To explore the effect and research of preoperative use of β-adrenergic receptor blocker on the scheduled surgery of middle-aged and elderly people. Methods 200 patients undergoing surgery in our hospital from January 2017 to January 2018 were randomly selected and divided into two groups according to the random number table method.Patients in two groups were given elective non-cardiac surgery under stable hypertension,and they were all given routine preoperative intervention.The observation group was given Betaloc according to the preoperative heart rate of patients.Cardiac troponin T(cTnT) and N-terminal pro-brain natriuretic peptide(NT-proBNP) were measured before and after operation in the two groups.The baroreflex sensitivity(BRS) was measured before operation and on 1 day after operation.The operation timing,incidence of perioperative cardiovascular events and incidence of adverse reactions of patients in two groups were recorded. Results The levels of cTnT and NT-proBNP after operation in observation group were lower than those in control group.The difference was statistically significant(P < 0.05).On 1 day after operation,BRS,low frequency and high frequency values in the observation group were higher than those in the control group,and the value of low frequency divided by high frequency was lower than that in control group.The difference was statistically significant(P< 0.05).The proportion of patients with surgery on schedule in observation group was higher than that in control group.The difference was statistically significant(P < 0.05).The incidence rate of perioperative cardiovascular events in observation group was lower than that in control group.The difference was statistically significant(P < 0.05).There was no serious adverse reaction in patients of the two groups. Conclusion β-adrenergic receptor blocker can lower the blood pressure and ensure that patients can undergo surgery as scheduled by blocking the adrenal β receptor.
引文
[1]郭杰,余灿清,吕筠,等.中国10个地区人群高血压患病率、知晓率、治疗率和控制情况分析[J].中华流行病学杂志,2016,37(4):469-474.
[2]张继如,王志强,季永,等.不同危险分层老年高血压患者围手术期心血管事件风险分析[J].中华高血压杂志,2016,95(4):400.
[3]陈源源.围手术期高血压的管理策略[J].中华高血压杂志,2017,25(8):786-789.
[4]中国高血压防治指南修订委员会.中国高血压防治指南[M].北京:人民卫生出版社,2016:11.
[5]佟秋艳.β肾上腺素受体阻滞剂在我国高血压治疗中的地位探讨[J].山西医药杂志,2016,45(18):2140.
[6]赵连友,孙宁玲,孙英贤,等.α/β受体阻滞剂在高血压治疗中应用的中国专家共识[J].中华高血压杂志,2016,36(6):521-526.
[7]郭晨跃,李懿,葛圣金,等.高血压患者胃肠道肿瘤手术前血压控制对术后心血管不良事件的影响[J].临床麻醉学杂志,2017,33(9):856-859.
[8]徐中山.高血压与交感神经系统的神经源性机制研究进展[J].中西医结合心脑血管病杂志,2015,13(13):1505-1508.
[9]谭颖颖,王亚运,张琪.电针“曲池”穴对中枢血管紧张素Ⅱ诱发的动脉血压升高大鼠异常交感神经活性的影响[J].针刺研究,2016,41(2):144-149.
[10]高秀荣,孙丽君,吉宗珊,等.不稳定型心绞痛心率变异性特点及美托洛尔对其的影响[J].现代生物医学进展,2016,16(26):5113-5116.
[11]冯颖青.β受体阻滞剂在降压治疗中的应用[J].心血管病学进展,2015,36(6):665-668.
[12]李丹丹,董蔚,陈韵岱,等.北京24家医院住院冠心病患者静息心率控制及β受体阻滞剂使用状况[J].中华医学杂志,2015,95(28):2272-2276.
[13]黄炯华,戴文军,林育辉,等.肾脏去神经联合美托洛尔对自发性高血压大鼠的血压和心脏肥厚的作用[J].临床心血管病杂志,2016,32(11):1159-1163.
[14]吴雷,耿国英,赵明虎.美托洛尔与比索洛尔治疗舒张性心力衰竭的疗效和安全性比较[J].中国药房,2016,27(18):2488-2490.
[15]胡霜,蔡莉,张川平.美托洛尔联合芪苈强心胶囊治疗慢性心力衰竭的疗效观察[J].重庆医学,2017,46(5):689-691.
[2]张继如,王志强,季永,等.不同危险分层老年高血压患者围手术期心血管事件风险分析[J].中华高血压杂志,2016,95(4):400.
[3]陈源源.围手术期高血压的管理策略[J].中华高血压杂志,2017,25(8):786-789.
[4]中国高血压防治指南修订委员会.中国高血压防治指南[M].北京:人民卫生出版社,2016:11.
[5]佟秋艳.β肾上腺素受体阻滞剂在我国高血压治疗中的地位探讨[J].山西医药杂志,2016,45(18):2140.
[6]赵连友,孙宁玲,孙英贤,等.α/β受体阻滞剂在高血压治疗中应用的中国专家共识[J].中华高血压杂志,2016,36(6):521-526.
[7]郭晨跃,李懿,葛圣金,等.高血压患者胃肠道肿瘤手术前血压控制对术后心血管不良事件的影响[J].临床麻醉学杂志,2017,33(9):856-859.
[8]徐中山.高血压与交感神经系统的神经源性机制研究进展[J].中西医结合心脑血管病杂志,2015,13(13):1505-1508.
[9]谭颖颖,王亚运,张琪.电针“曲池”穴对中枢血管紧张素Ⅱ诱发的动脉血压升高大鼠异常交感神经活性的影响[J].针刺研究,2016,41(2):144-149.
[10]高秀荣,孙丽君,吉宗珊,等.不稳定型心绞痛心率变异性特点及美托洛尔对其的影响[J].现代生物医学进展,2016,16(26):5113-5116.
[11]冯颖青.β受体阻滞剂在降压治疗中的应用[J].心血管病学进展,2015,36(6):665-668.
[12]李丹丹,董蔚,陈韵岱,等.北京24家医院住院冠心病患者静息心率控制及β受体阻滞剂使用状况[J].中华医学杂志,2015,95(28):2272-2276.
[13]黄炯华,戴文军,林育辉,等.肾脏去神经联合美托洛尔对自发性高血压大鼠的血压和心脏肥厚的作用[J].临床心血管病杂志,2016,32(11):1159-1163.
[14]吴雷,耿国英,赵明虎.美托洛尔与比索洛尔治疗舒张性心力衰竭的疗效和安全性比较[J].中国药房,2016,27(18):2488-2490.
[15]胡霜,蔡莉,张川平.美托洛尔联合芪苈强心胶囊治疗慢性心力衰竭的疗效观察[J].重庆医学,2017,46(5):689-691.