Haas Curtis E, LeBlanc Jaclyn M
Critical Care, Department of Pharmacy Practice, School of Pharmacy and Pharmaceutical Sciences, University at Buffalo, Buffalo, NY 14260-1200, USA.
Am J Health Syst Pharm. 2004 Aug 15;61(16):1661-73; quiz 1674-5.
The pathophysiology and treatment of acute postoperative hypertension (APH) are discussed.
APH is a significant elevation in arterial blood pressure (BP) during the immediate postoperative period. The predominant underlying mechanism appears to be sympathetic activation. APH may lead to serious neurologic, cardiovascular, or surgical-site complications and often requires intervention and management. Postoperative hypertension lasts less than six hours in most patients. Reversible or treatable causes of hypertension, including pain, anxiety, hypothermia, and hypoxemia, should be considered and treated before the implementation of antihypertensive therapy. The ideal agent for treating APH is intravenously administered, is fast acting, and has a short duration of action, allowing the rapid and safe adjustment of therapy to achieve a targeted BP range. Sodium nitroprusside has long been considered the standard therapy and has many of the ideal characteristics. However, because of the need for invasive hemodynamic monitoring and concerns about toxicity in patients given sodium nitroprusside, several newer agents may be preferable in routine clinical practice. Labetalol, nicardipine, and nitroglycerin have been widely studied or used. Hydralazine, esmolol, fenoldopam, angiotensin-converting-enzyme inhibitors, and clonidine may also be useful treatment options.
When treatment of APH is necessary, therapy should be individualized for the patient. No one agent is preferred, but effective options include sodium nitroprusside, nitroglycerin, labetalol, and nicardipine.
探讨急性术后高血压（APH）的病理生理学及治疗方法。
APH是术后即刻动脉血压（BP）显著升高。主要潜在机制似乎是交感神经激活。APH可能导致严重的神经、心血管或手术部位并发症，常需要进行干预和管理。大多数患者术后高血压持续时间不到6小时。在实施抗高血压治疗前，应考虑并治疗高血压的可逆或可治疗原因，包括疼痛、焦虑、体温过低和低氧血症。治疗APH的理想药物应通过静脉给药，起效迅速，作用时间短，以便能快速安全地调整治疗以达到目标血压范围。硝普钠长期以来一直被视为标准治疗药物，具有许多理想特性。然而，由于需要有创血流动力学监测以及对使用硝普钠患者的毒性担忧，在常规临床实践中几种新型药物可能更可取。拉贝洛尔、尼卡地平及硝酸甘油已得到广泛研究或应用。肼屈嗪、艾司洛尔、非诺多泮、血管紧张素转换酶抑制剂及可乐定也可能是有用的治疗选择。
当有必要治疗APH时，治疗应针对患者个体化。没有一种药物是首选，但有效的选择包括硝普钠、硝酸甘油、拉贝洛尔及尼卡地平。
