| Objective: 1.To analyze the current epidemiological situation of patients undergoing ophthalmic surgery,so as to further explore the proportion of complicating disease and high blood pressure in eye patients in South Sichuan. 2.To observe the influence of both methods on the perioperative hemodynamic of patients with hypertension stage II~III,and the change of catecholamine in the plasma,and perform initial effect evaluation on both methods. Methods: 1.The data of ophthalmic surgery patients in our hospital from September 2014 to December 2014 was collected,and the proportion of elderly patients in ophthalmic surgery,the proportion of high-risk complications such as disease of high blood pressure,heart disease,diabetesand lung disease was analyzed.The hypertension patients’ awareness,treatment and control rate was also analyzed. 2.60 cases of elderly patients with hypertension undergoing eye surgery with local anesthesia were randomly selected.The patients ages were≥65 years old,ASA II~III level.All received preoperative hypertension treatment,and had stable blood pressure.The blood pressure was<150/90 mm Hg.Patients with blood pressure higher than 160/90 mm Hg on the first arriral of the operation room were also enrolled into this trial.They were divided ramdomly into 3 groups.All the patients received intervention drugs on arrival of the operation room.After 5 minutes, the patients with blood pressure lower than 180/110 mm Hg would receive the s- urgery.If patients blood pressure were higher than 180/110 mm Hg,the operation would be suspended.Ever since then,the patients would recive the same intervention drug till the proceeding of the surgery.The patients were into three groups using a randomized,double blind method:midazolam+nitroglycerin group(group A),midazolam+nicardipine group(group B)and the control group(group C), with 20 cases in each group.The observe time points were:before delivery(T0),5 min after the treatment(T1),injection of local anesthetic(T2),5 min after surgery(T3),10 min after surgery(T4),30 min after surgery(T5),the end of the operation(T6),postoperative 1h(T7) and postoperative 6h(T8).Noninvasive cuff systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MBP),heart rate(HR),heart rate-systolic blood pressure product(RPP), pulse oxygen saturation(Sp O2),breathing rate(RR) and sedation analgesia scores were recoeded.Patients’ venous blood was collected for measurement of plasma epinephrine(E),noradrenaline(NE) and dopamine(D) prior to the delivery and at the end of surgery.Stop operation time and hospitalization time were recorded.Postoperative adverse reactions such as nausea,vomiting,hypotension and other side effects were observed.Postoperative adverse events happened within 24 h,such as stroke,myocardial infarction,secondary surgery for intraocular hemorrhage were recorded. Results: 1.From September 2014 to December 2014 altogether 499 in hospital cases of patients with ophthalmic surgery were collected.The majority of the ophthalmic surgery patients were elderly patients(43.1%).The proportion of patients combined body disease of high blood pressure,heart disease,diabetes, lung disease,was 32.7%,20.0%,10.9%,7.2% respectively,among which the hyp- ertension had the highest proportion.Hypertension awareness,treatment and control rates were 66.3%,46.0% and 34.2% respectively. 2.Comparison of SBP: comparison between groups:SBP in group A and B in T0 time point significantly were higher than that of group C(P<0.05).There was no statistically significant difference between three groups at T1 time point(P>0.05).The group A and B in T2~T6 time point was significantly lower than that of group C(P<0.05);Inter group comparison:the group A and B in T1~T8 time point was significantly decrease than T0(P<0.05),the T2 time point of group A and C was significantly higher than T1 and T3~T8(P<0.05).Comparison of MAP:comparison between roups:the group A and B in T0 time point was significantly higher than that of group C(P<0.05),the group C in T4 and T6 time point was significantly higher than A and B group(P>0.05);Inter group comparison:the group A and B in T1~ T8 time point was significantly lower than T0(P<0.05),the group C T1,T3,T5~ T8 time point was significantly lower than T0(P<0.05),the group A and B in T3 ~T8 time point was significantly lower than T2(P<0.05),the group C in T2 time point was significantly higher than that of T1,T3~T8(P<0.05).Groups of DBP comparison:the group A and B in T0 time point was significantly higher than that of group C(P<0.05),three groups of T1~T8 time point was no statistically significant difference(P>0.05).Comparison of HR:three groups of T0 point was no statistically significant difference(P>0.05),the B group in T3 and T4 time point was significantly slower than C group(P<0.05).Comparison of RPP:There was no significant difference beteen three groups at T0 and T1 time point(P> 0.05),RPP of A group in T3~T6 time point was significantly lower than C group(P<0.05),RPP in T2~T6 time point of B group was significantly lower than C group(P<0.05).Comparison of RR:Comparison between groups:the group A and B in T1~T6 time point was lower than that of group C(P<0.05).Comparison of Sp O2:There was no significant difference between three groups(P>0.05).Groups of E,NE and D comparison:NE and D of C Group in T6 time point was significantly higher than A and B group(P<0.05);E and D of A group in T6 time point was significantly lower than T0(P<0.05);E,NE and D of B group in T6 point was significantly lower than T0(P<0.05).Each group’s Rasmay sedation score comparison:There was no significant difference between three groups at T0(P> 0.05).Rasmay sedation score of A and B group in T1~T6 time point was higher than that of group C(P<0.05).There was no significant difference in VAS pain scores between the three groups.Each group’s operation and hospitalization time comparing:Stop the operation cases of C group was significantly more than the number of cases in A and B group(P<0.05).Operation suspension rate of C g- roup was significantly higher than A and B group(P<0.05).The length of hospital stay of A and B group was significantly shorter than C group(P<0.05). Conlusion: 1.The old patients hospitalized due to the ophthallmology are regarded as the major group.The whole-body complications and hypertension account for the biggest proportion.The hypertension awareness rate,treatment rate and control rate is 66.3%, 46.0 % and 34.2% respectively. 2.Midazolam combined with nitroglycerin and nicardipine respectively for elderly eye surgery with local anesthesia hypertension,can provide satisfactive sedation and had no adverse effects on breathing. 3.Midazolam combined with nitroglycerin and nicardipine respectively for perioperative sedation can reduce the stress response,blood pressure and catecholamine levels. 4.Midazolam combined with nitroglycerin and nicardipine respectively for perioperative sedation reduced patient’s blood pressure effectively,with a stable hemodynamic during the surgery,and is safe for patients with blood pressure between 160/90 mm Hg and 180/110 mm Hg. 5.Midazolam combined with nitroglycerin and nicardipine respectively shortened the patient’s hospital stay. |
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