-
研究[1]显示,胃镜检查可明显影响病人的血压水平,以及诱发心律失常、心肌梗死、脑卒中等,大大增加检查的危险性,而高血压高危病人则面临更大的风险。硝酸甘油静脉滴注控制性降压效果明显[2-5],但目前国内外尚未有将静脉滴注硝酸甘油控制性降压应用于高血压高危病人胃镜检查的前瞻性研究。因此,本研究探讨静滴硝酸甘油控制性降压在高血压高危病人行胃镜检查时的保护作用,并与口服硝苯地平及硝酸甘油片降压的效果进行比较。现作报道。
-
检查前,A、B、C组病人收缩压(SBP)均明显高于对照组(P<0.01);A、B组病人HR均高于对照组(P<0.05)。检查过程中,A、B组病人SBP、舒张压(DBP)均明显高于C组和对照组(P<0.01);A组HR均高于C组和对照组(P<0.01和P<0.05)。检查后,A组SBP和HR均高于C组和对照组(P<0.05~P<0.01)。C组病人除检查前SBP和检查后HR高于对照组(P<0.01和P<0.05)外,各检查阶段的其他指标与对照组差异均无统计学意义(P>0.05)(见表 1)。
分组 SBP/mmHg DBP/mmHg HR/(次/分) SpO2/% 检查前 A组 141.60±8.47 84.05±6.31 86.28±13.45 97.85±1.10 B组 140.30±6.32 85.72±5.41 84.35±9.14 98.55±0.85 C组 138.68±7.98 84.48±8.65 82.10±10.53 98.02±1.76 对照组 133.22±6.60**##▲▲ 83.28±5.85 78.12±12.19*# 98.30±1.18 F 9.93 0.94 3.75 2.37 P <0.01 >0.05 <0.01 >0.05 MS组内 54.731 44.532 130.980 1.606 检查中 A组 169.32±19.60 94.25±13.97 111.02±25.24 97.85±1.12 B组 178.65±10.68* 97.38±10.52 102.68±13.28 96.02±14.14 C组 152.05±17.21**## 86.58±11.60**## 97.05±15.82** 98.02±1.75 对照组 151.90±19.71**## 84.40±11.30**## 98.68±18.78* 98.38±1.51 F 23.81 10.69 4.40 0.86 P <0.01 <0.01 <0.01 >0.05 MS组内 295.723 142.020 354.094 51.634 检查后 A组 148.80±12.20 90.15±9.46 94.20±14.58 97.90±0.96 B组 146.72±11.99 88.58±7.25 89.40±9.81 98.52±0.68 C组 141.95±10.71* 85.92±8.03 85.60±10.00** 98.02±1.69 对照组 140.20±14.12* 86.75±9.99 78.90±12.21**##▲ 98.40±1.39 F 4.25 1.87 11.97 2.28 P <0.01 <0.01 <0.01 >0.05 MS组内 151.670 76.584 139.474 1.543 q检验:与A组比较*P<0.05,**P<0.01;与B组比较#P<0.05,##P<0.01;与C组比较▲P<0.05,▲▲P<0.01 表 1 4组受检者不同检查阶段的临床指标比较(ni=40;x±s)
-
检查前和检查后,3组病人窦性心动过速、ST改变、异位心律(包括房早、室早、室上性心动过速)、传导阻滞4种异常心电图发生率差异均无统计学意义(P>0.05)。检查过程中,3组ST改变和异位心律差异均有统计学意义(P<0.05)(见表 2)。
分组 窦性心动过速 ST改变 异位心律 传导阻滞 检查前 A组 4 3 5 3 B组 3 5 3 3 C组 3 4 4 5 χ2 0.22 0.56 0.56 0.80 P >0.05 >0.05 >0.05 >0.05 检查中 A组 21 13 14 3 B组 14 6 6 4 C组 11 4 5 5 χ2 5.57 7.21 7.38 0.56 P >0.05 <0.05 <0.05 >0.05 检查后 A组 10 7 6 3 B组 4 9 3 3 C组 3 7 4 5 χ2 5.89 0.43 1.21 0.80 P >0.05 >0.05 >0.05 >0.05 表 2 3组高血压病人心电图改变比较(ni=40)
-
将病人在检查过程中发生的恶心、呕吐、呛咳、流涎、体动、头晕、面红、心慌等反应列为不良反应。A组病人发生不良反应(5.85±5.00)次,B组(5.62±2.73)次,C组(4.80±3.27)次,对照组(5.88±5.36)次,4组受检者不良反应发生次数差异无统计学意义(F=0.570,P>0.05, MS组内=17.969)。
静脉滴注硝酸甘油控制性降压在高血压高危人群胃镜检查中的应用
Application value of intravenous nitroglycerin controlled hypotension in the gastroscopy of high risk population with hypertension
-
摘要:
目的探讨硝酸甘油静脉滴注控制性降压在高血压高危人群胃镜检查中的应用,并比较其与口服硝苯地平及硝酸甘油片降压的效果。 方法选取行电子胃镜检查的高血压高危人群120例,随机分为3组,各40例。行胃镜检查前15 min,3组分别给予硝苯地平片口服(A组)、硝酸甘油片口服(B组)和硝酸甘油静脉滴注(C组)降压。另抽取40名血压正常的受检者作为对照组。比较4组受检者在检查前、检查中、检查后的血压、心率和心电图改变情况,记录4组不良反应发生情况。 结果检查前,A、B组病人收缩压和心率均高于对照组(P < 0.05~P < 0.01);检查中,A、B组收缩压、舒张压和A组心率均高于C组和对照组(P < 0.05~P < 0.01);检查后,A组收缩压和心率均高于C组和对照组(P < 0.05~P < 0.01)。C组病人除检查前收缩压和检查后心率高于对照组(P < 0.01和P < 0.05)外,各检查阶段的其他指标与对照组差异均无统计学意义(P>0.05)。检查前和检查后,3组病人窦性心动过速、ST改变、异位心律(包括房早、室早、室上性心动过速)、传导阻滞4种异常心电图发生率差异均无统计学意义(P>0.05);检查过程中,3组ST改变和异位心律差异均有统计学意义(P < 0.05)。4组受检者不良反应差异无统计学意义(P>0.05)。 结论硝酸甘油静脉滴注在高血压高危人群行胃镜检查过程中能平稳控压,较口服硝苯地平片及硝酸甘油片效果更佳,有助于保障高血压病人安全。 Abstract:ObjectiveTo investigate the application value of intravenous nitroglycerin controlled hypotension in the gastroscopy of high risk population with hypertension, and compare the effects between nitroglycerin and nifedipine by oral in controlling blood pressure. MethodsOne hundred and twenty hypertensive patients treated with electronic gastroscopy were randomly divided into the group A(treatment with nifedipine by oral), group B(treatment with nitroglycerin by oral), and group C(treatment with intravenous nitroglycerin).Forty healthy people were set as control group.The blood pressure, heart rate, ECG and incidence rate of adverse reactions in four groups were observed through the whole process of gastroscopy inspection. ResultsBefore inspection, the levels of systolic blood pressure and heart rate in group A and group B were higher than those in control group(P < 0.05 to P < 0.01).During the inspection, the levels of systolic and diastole pressure in group A and group B, and heart rate in group A were higher than those in group C and control group(P < 0.05 to P < 0.01).After inspection, the level of systolic pressure and heart rate in group A were higher than those in group C and control group(P < 0.05 to P < 0.01).The level of systolic pressure before inspection and heart rate after inspection in group C were higher than those in control group(P < 0.01 and P < 0.05), and the differences of other indexes between group C and control group were not statistically significant(P>0.05).Before and after inspection, the differences of the incidence rates of sinus tachycardia, ST change, ectopic heart rhythm and conduction block among three groups were not statistically significant(P>0.05).During the inspection, the differences of ST change and ectopic heart rhythm among three groups were statistically significant(P < 0.05).The differences of the incidence rates of adverse reactions among four groups were not statistically significant(P>0.05). ConclusionsIntravenous nitroglycerin is a safe method in controlling the blood pressure during gastroscopy, the effect of which is better than that of nifedipine and nitroglycerin by oral. -
Key words:
- hypertension /
- gastroscopy /
- nitroglycerin /
- nifedipine
-
表 1 4组受检者不同检查阶段的临床指标比较(ni=40;x±s)
分组 SBP/mmHg DBP/mmHg HR/(次/分) SpO2/% 检查前 A组 141.60±8.47 84.05±6.31 86.28±13.45 97.85±1.10 B组 140.30±6.32 85.72±5.41 84.35±9.14 98.55±0.85 C组 138.68±7.98 84.48±8.65 82.10±10.53 98.02±1.76 对照组 133.22±6.60**##▲▲ 83.28±5.85 78.12±12.19*# 98.30±1.18 F 9.93 0.94 3.75 2.37 P <0.01 >0.05 <0.01 >0.05 MS组内 54.731 44.532 130.980 1.606 检查中 A组 169.32±19.60 94.25±13.97 111.02±25.24 97.85±1.12 B组 178.65±10.68* 97.38±10.52 102.68±13.28 96.02±14.14 C组 152.05±17.21**## 86.58±11.60**## 97.05±15.82** 98.02±1.75 对照组 151.90±19.71**## 84.40±11.30**## 98.68±18.78* 98.38±1.51 F 23.81 10.69 4.40 0.86 P <0.01 <0.01 <0.01 >0.05 MS组内 295.723 142.020 354.094 51.634 检查后 A组 148.80±12.20 90.15±9.46 94.20±14.58 97.90±0.96 B组 146.72±11.99 88.58±7.25 89.40±9.81 98.52±0.68 C组 141.95±10.71* 85.92±8.03 85.60±10.00** 98.02±1.69 对照组 140.20±14.12* 86.75±9.99 78.90±12.21**##▲ 98.40±1.39 F 4.25 1.87 11.97 2.28 P <0.01 <0.01 <0.01 >0.05 MS组内 151.670 76.584 139.474 1.543 q检验:与A组比较*P<0.05,**P<0.01;与B组比较#P<0.05,##P<0.01;与C组比较▲P<0.05,▲▲P<0.01 表 2 3组高血压病人心电图改变比较(ni=40)
分组 窦性心动过速 ST改变 异位心律 传导阻滞 检查前 A组 4 3 5 3 B组 3 5 3 3 C组 3 4 4 5 χ2 0.22 0.56 0.56 0.80 P >0.05 >0.05 >0.05 >0.05 检查中 A组 21 13 14 3 B组 14 6 6 4 C组 11 4 5 5 χ2 5.57 7.21 7.38 0.56 P >0.05 <0.05 <0.05 >0.05 检查后 A组 10 7 6 3 B组 4 9 3 3 C组 3 7 4 5 χ2 5.89 0.43 1.21 0.80 P >0.05 >0.05 >0.05 >0.05 -
[1] ROSS R, NEWTON JL.Heart rate and blood pressure changes during gastroscopy in healthy older subjects[J].Gerontology, 2004, 50(3):182. doi: 10.1159/000076778 [2] WANG L, HORIUCHI I, MIKAMI Y, et al.Use of intra-arterial nitroglycerin during uterine artery embolization for severe postpartum hemorrhage with uterine artery vasospasm[J].Taiwan J Obstet Gynecol, 2015, 54(2):187. doi: 10.1016/j.tjog.2014.05.006 [3] DHARMA S, KEDEV S, PATEL T, et al.A novel approach to reduce radial artery occlusion after transradial catheterization:postprocedural/prehemostasis intra-arterial nitroglycerin[J].Catheter Cardiovasc Interv, 2015, 85(5):818. doi: 10.1002/ccd.25661 [4] SAND L, LUNDIN S, RIZELL M, et al.Nitroglycerine and patient position effect on central, hepatic and portal venous pressures during liver surgery[J].Acta Anaesthesiol Scand, 2014, 58(8):961. doi: 10.1111/aas.2014.58.issue-8 [5] CLARK DR, TESSENEER S, TRIBBLE CG.Nitroglycerin and sodium nitroprusside:potential contributors to postoperative bleeding[J].Heart Surg Forum, 2012, 15(2):92. doi: 10.1532/HSF98.20111109 [6] 周冬喜, 储静红, 刘华, 等.右美托咪定联合硝酸甘油在腰椎手术控制性降压中的应用[J].现代医药卫生, 2015, 31(5):668. doi: 10.3969/j.issn.1009-5519.2015.05.011 [7] 王静, 陈卫刚, 田书信, 等.高血压患者行无痛胃镜与普通胃镜检查的安全性分析120例[J].世界华人消化杂志, 2015, 23(5):788. [8] GU Q, WU C, GU L, et al.Comparison of the cardiovascular impacts of transnasal versus transoral gastroscopy in the aged patients with or without hypertension[J].Hepatogastroenterology, 2009, 56(94/95):1562. [9] FUJITA R, KUMURA F.Arrythmias and ischemic changes of the heart induced by gastric endoscopic procedures[J].Am J Gastroenterol, 1975, 64(1):44. [10] EBI M, SHIMURA T, NISHIWAKI H, et al.Management of systolic blood pressure after endoscopic submucosal dissection is crucial for prevention of post-ESD gastric bleeding[J].Eur J Gastroenterol Hepatol, 2014, 26(5):504. doi: 10.1097/MEG.0000000000000072 [11] 刘力生, 吴兆苏, 朱鼎良, 等.中国高血压防治指南2010版[J].中国医学前沿杂志, 2011, 3(5):42. doi: 10.3969/j.issn.1674-7372.2011.05.011 [12] 李秋荣, 郭晓文.硝酸甘油复合瑞芬太尼用于鼻内镜手术控制性降压效果观察[J].中国药物与临床, 2014, 14(1):85. [13] 潘志强, 刘庆, 程璠, 等.硝酸甘油控制性降压在局部麻醉下三叉神经根减压术中的应用[J].临床合理用药杂志, 2013, 6(9):37. doi: 10.3969/j.issn.1674-3296.2013.09.026 [14] 陈曦, 程广书, 范军铭.中西医结合诊疗方案治疗中青年2级高血压病的多中心随机对照试验[J].中国中西医结合杂志, 2015, 35(7):801. [15] 刘旭东, 付坚, 封木忠, 等.金匮肾气丸联合硝苯地平控释片治疗老年脾肾阳虚型高血压的效果观察[J].中国中药杂志, 2015, 40(24):4908. [16] MANZUR-VERASTEGUI S, MANDEVILLE PB, GORDILLO-MOSCOSO A, et al.Efficacy of nitroglycerine infusion versus sublingual nifedipine in severe pre-eclampsia:a randomized, triple-blind, controlled trial[J].Clin Exp Pharmacol Physiol, 2008, 35(5/6):580. [17] 何裕科.硝苯地平舌下含服与硝酸甘油静脉滴注治疗高血压急诊患者的疗效[J].中国医学创新, 2016, 13(3):51. doi: 10.3969/j.issn.1674-4985.2016.03.016 [18] 李建辉, 陈韶景, 梁雁芬.硝酸甘油静脉滴注与硝苯地平舌下含服院前急救高血压急症的比较观察[J].广东医学院学报, 2014, 32(4):538. doi: 10.3969/j.issn.1005-4057.2014.04.052