DOI: https://doi.org/10.22141/2224-0586.2.89.2018.126606

Features of intraoperative regulation of arterial pressure in patients with hypertension

O.A. Loskutov, V.G. Kolesnykov, D.V. Shabanov, A.N. Druzhyna

Abstract


The work determines the influence of arterial hypertension on the development of postoperative complications in elderly patients undergoing coronary artery bypass grafting, and studies the effectiveness of different methods for intraoperative regulation of blood pressure. The study inclu­ded 96 patients with hypertension stage 1–3, who underwent coronary artery bypass grafting with 2–3 coronary venous anastomoses. As a result of work, it was determined that at the stage of laryngoscopy, patients with concomitant hypertension had hemodynamic disorders of two types: reduced blood pressure due to vasodilation and reduced compensatory abi­lity of the myocardium; the hemodynamic pressure response in the form of increased blood pressure on the stage of intubation related to sympathetic impulsation, irritation of deep sensory receptors of the larynx and a rapid increase in the level of endogenous catecholamines. Concomitant diabetes mellitus was identified in 22.9 % of patients. The presence of this disease determined the reduction in stroke volume by 21.30 ± 1.21 % and cardiac index by 12.5 ± 1.3 %, the index of contractility — by 14.60 ± 1.31 %. In the early postoperative period, 7.3 % of patients with hypertension had encephalopathy and a number of postoperative cognitive dysfunctions, which is associated with recalibration of cerebral vessels on the background of hypertension.

Keywords


perioperative arterial hypertension; coronary artery bypass surgery; anesthesia in arterial hypertension

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