第十九章心血管病人非心脏手术的麻醉课件.ppt

第十九章 心血管病人非心脏手术的麻醉 PREIOPERATIVE POTENTIAL DRUGS ADVANTAGES DISADVANTAGES Digitalis glycosides Inotropic effect Arrhythmias Control of ventricular response Exacerbation of hypokalemia to rapid atrial rates ?-Adrenergic Less tachycardia, dysrhythmias Bronchospasm, less response to receptor blockers and hypertention ?-stimulants Calcium channel Control dysrhythmias Reduced response to inotropes blockers Prevent coronary artery spasm and vasopressors Reduce hypertention Atrioventricular conduction block Peripheral vasodilation after CPB Antihypertension Less hypertension Drug interactions drugs Peripheral vasodilation after CPB Diuretics Probably none Hypokalemia, hypovolemia Antiarrhythmic Suppression of dysrhythmia Enhanced toxicity with changes drugs in PH and electrolytes Aspirin Reduced risk of thrombosis Increased risk of excessive bleeding 第三节 高血压病人的麻醉原则 ?高血压(hypertension)是以体循环动脉压增高 为主的临床综合征 ?临床上高血压分为二类： 原发性高血压（essential hypertension), 又称高血压病 继发性高血压（secondary hypertension), 症状性高血压 ?血压水平的定义和分类见表： 血压水平的定义和分类（WHO/LSH) 围术期高血压的危害 心脏意外或并发症发生率↑ 脑卒中发生率↑ 肾功能异常发病率↑ 收缩压每增高10mmHg,心肌缺血发生率增加1.3倍,脑卒中发生率