Aronson Solomon
Department of Anesthesiology, Duke University School of Medicine, Box 3094, 102 Baker House, Durham, NC, 27710, USA,
Curr Hypertens Rep. 2014 Jul;16(7):448. doi: 10.1007/s11906-014-0448-6.
The concept of "perioperative hypertensive emergency" must be defined differently from that of ambulatory hypertensive emergency in view of its unique clinical considerations in an atypical setting. It should be noted that moderately high normal blood pressure (BP) values in the perioperative setting often trigger situations requiring immediate treatment in what would otherwise be a "BP-acceptable" non-surgical condition. Commonly recognized circumstances that may result in a perioperative hypertensive emergency include exacerbation of severe mitral insufficiency, hypertension resulting in acute decompensated heart failure, hypertension caused by acute catecholamine excess, rebound hypertension after withdrawal of antihypertensive medications, hypertension resulting in bleeding from vascular surgery suture lines, intracerebral hemorrhage, aortic dissection, hypertension associated with preeclampsia, and hypertension associated with autonomic dysreflexia. In addition, perioperative BP lability has been reported to increase the risk for stroke, acute kidney injury, and 30-day mortality in patients undergoing cardiac surgery.
鉴于围手术期高血压急症在非典型情况下具有独特的临床考量因素，其概念必须与门诊高血压急症的概念有所不同。应当注意的是，围手术期血压（BP）值略高于正常范围，在其他情况下若血压处于“可接受”水平则无需手术干预，但在围手术期却常常引发需要立即治疗的情况。公认的可能导致围手术期高血压急症的情形包括重度二尖瓣关闭不全加重、高血压导致急性失代偿性心力衰竭、急性儿茶酚胺过量引起的高血压、停用抗高血压药物后的反跳性高血压、高血压导致血管外科手术缝合处出血、脑出血、主动脉夹层、子痫前期相关高血压以及自主神经反射异常相关高血压。此外，据报道，围手术期血压波动会增加心脏手术患者发生中风、急性肾损伤和30天死亡率的风险。
