Leslie J B
Department of Cardiac Anesthesia, Duke University Medical Center, Durham, North Carolina.
Acta Anaesthesiol Scand Suppl. 1993;99:5-9. doi: 10.1111/j.1399-6576.1993.tb03816.x.
The reported incidence of perioperative hypertension associated with coronary artery bypass-graft (CABG) surgery ranges from 30-80%, which may reflect the various definitions of the condition as well as differences in the patients' preoperative states. Systolic, diastolic and mean arterial blood pressures are variously used to define perioperative hypertension, but absolute values range from a target systolic blood pressure of below 170 mmHg in some studies to below 110 mmHg in others. Patients' preoperative states have been extensively studied to determine potential risk factors. The majority of these studies indicate that perioperative hypertension is predictive of perioperative cardiac morbidity, but others do not confirm this finding, rendering the issue unresolved. The consequences of perioperative hypertensive episodes include bleeding from vascular suture lines, cerebrovascular haemorrhage or subendocardial ischaemia, and are associated with a mortality rate that may approach 50%. Increases in peripheral vascular resistance (PVR), caused by elevated levels of circulating catecholamines, appear to be the primary aetiology. Antihypertensive agents which correct or prevent the increase in PVR would appear to be the most appropriate therapy. However, no single agent appears to be ideal for all hypertensive episodes, suggesting multiple potential aetiologies.
据报道，冠状动脉旁路移植术（CABG）围手术期高血压的发生率在30%至80%之间，这可能反映了该病症的各种定义以及患者术前状态的差异。收缩压、舒张压和平均动脉压被不同地用于定义围手术期高血压，但绝对值范围从一些研究中的目标收缩压低于170 mmHg到另一些研究中的低于110 mmHg不等。已对患者的术前状态进行了广泛研究，以确定潜在的危险因素。这些研究大多表明围手术期高血压可预测围手术期心脏发病率，但其他研究并未证实这一发现，使得该问题仍未得到解决。围手术期高血压发作的后果包括血管缝合线出血、脑血管出血或心内膜下缺血，并且与可能接近50%的死亡率相关。循环儿茶酚胺水平升高引起的外周血管阻力（PVR）增加似乎是主要病因。纠正或预防PVR增加的抗高血压药物似乎是最合适的治疗方法。然而，没有一种药物似乎对所有高血压发作都是理想的，这表明存在多种潜在病因。
