围术期ICU患者高血压和心血管险综合管理策略.ppt

围术期ICU患者高血压和心血管风险综合管理策略：小结 下列围术期高血压ICU病人群更适合使用尼卡地平 冠心病患者 脑供血不足或功能障碍患者 合并肾功能不全患者 老年患者 尼卡地平作用特点 先快后慢，稳步控制血压； 降压平稳，血压波动少，无血压反跳； 疗效持续，血压可24小时稳定在较窄范围； 用药方式和体重无关，剂量调整方便； 重要靶器官保护 谢 谢 对于生命的支持 开始就正确可贵 先行降压先锋开始就正确 * 内容分为两部分进行讲述： 1.围手术期血压管理有助于改善手术预后 2.佩尔：围手术期静脉用降压药物一线选择： 预后改善证据 药理学特性和降压特性 靶器官保护特性 * 我们知道，围术期高血压是手术常见并发症或合并症。其中，外科手术患者术后约6%可出现围术期高血压，术前高血压病史的外科患者25%可出现围手术期高血压，这在临床手术科室均存在，其中以心血管外科、神经外科更为常见(30%–80%)。 * * Emerging data implicate systolic BP as a more important prognostic indicator in the perioperative setting than diastolic BP. Aronson et al reported on a prospective observational study of 2069 patients who underwent CABG surgery. Preoperative isolated systolic hypertension (ISH) was associated with an increased risk for postoperative cerebral, renal, and cardiovascular adverse events. Perioperative ISH associated with postoperative adverse events 围术期高血压可导致围术期不良事件如心肌缺血或梗死、左心衰竭和/或肺水肿、手术部位出血、脑出血等增加。 围术期血压管理有助于降低围术期不良事件的发生。 * * Acute hypertension is characterized by a complex series of events triggered by mechanical stress and release of neurohormonal mediators. Summary: The pathophysiology of acute hypertensive syndromes * The perioperative period is associated with release of several mediators of inflammation, thrombosis, and vasoconstriction, which together set the stage for plaque rupture and thrombus formation. Increased oxygen demand coupled with decreased oxygen delivery secondary to hypoxia results in mycoardial ischemia, which is strongly associated with perioperative myocardial infarction. Proposed mechanisms of perioperative MI 内容分为两部分进行讲述： 1.围手术期血压管理有助于改善手术预后 2.佩尔：围手术期静脉用降压药物一线选择： 预后改善证据 药理学特性和降压特性 靶器官保护特性 * * The preceding slides in this curriculum have demonstrated that acute vascular injury secondary to acute changes in BP can have long-term effects, regardless of whether these BP excursions are above or below optimal levels. It then follows that treatment strategies should be directed to the prevention of exaggerated BP variation in eithe