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由于术前大多数病人即有继发或原发的高血压,术前术中精神紧张,应用大剂量皮质激素和环孢素预防排斥反应,水中输血和输液过多导致容量负荷增重,术后麻醉药物逐渐代谢或排泄,加之术后动静脉吻合、水肿狭窄致使血压骤然升高等因素,使得肾移植术后当天最易发生高血压危象。本文述及30例患者在肾移植术后当天出现高血压危象,均在用普通降压药不理想的情况下采用硝酸甘油加入0.9％盐水200ml持续静滴,根据血压调滴数,浓度为20～40ug/min,最高达60ug/min,用药2～8h。结果所有患者均在用药5～20min起效,症状缓解至有效的时间为20min～1h,平均35min。通过临床观察证实该药具有起效快,降低外周血管阻力,但不影响心输出量,对心肾并发症有利,对肾移植术后所伴发的左心功能不全及急性肾功能不全可谓一举两得。因此特别适合肾移技术后高血压危象的首选治疗。
Because most patients before surgery, there are secondary or primary hypertension, preoperative tension during surgery, the application of high-dose corticosteroids and cyclosporine to prevent rejection, water transfusion and infusion overload capacity overload caused by surgery After gradual metabolism or excretion of anesthetic drugs, combined with arteriovenous anastomosis, edema caused by sudden narrowing of blood pressure and other factors, making the most prone to hypertensive crisis the day after kidney transplantation. This article describes the 30 patients on the day after renal transplantation appear hypertensive crisis, are in the case of ordinary antihypertensive drugs are not ideal with nitroglycerin plus 0.9% saline 200ml continuous intravenous infusion, according to the number of blood pressure drops, the concentration of 20 ~ 40ug / min, up to 60ug / min, medication 2 ~ 8h. Results All patients were treated with drugs for 5 ~ 20min. The time from symptom relief to effective time was 20min ~ 1h with an average of 35min. Through clinical observation confirmed that the drug has rapid onset and reduce peripheral vascular resistance, but does not affect the cardiac output, the advantages of heart and kidney complications, renal transplantation associated with left ventricular dysfunction and acute renal insufficiency can be described as double benefit . It is particularly suitable for the treatment of hypertensive crisis after renal transplantation.