高血壓病人手術期間血壓穩定程度及其相關因素研究-以某醫學中心腹腔鏡膽囊切除手術為例

Abstract

摘要 本研究旨在探討高血壓病人在手術期間血壓穩定程度及其相關因素， 採用病歷回溯方式，以醫學中心進行腹腔鏡膽囊切除手術的高血壓病人 為母群體；以立意取樣選取 2016 年 1 月到 2017 年 6 月進行腹腔鏡膽囊 切除手術的高血壓病人為樣本，共得有效樣本 325 人。資料經處理與統計分析後，得以下研究結果：

一、 研究對象中男女約各占一半，50-79 歲者約占七成以上，體位過重 或肥胖者占六成七，在手術前有服用降血壓藥物者約占六成，有近一半 的人有高血壓家族疾病史，而研究對象中約有四成的人手術期間的血壓 不穩定。 二、研究對象的「年齡」、「身體質量指數」、「手術前服用降血壓藥物情 形」三者與手術期間血壓穩定程度有關係，年齡越高者手術期間血壓越 不穩定；而身體質量指數(BMI)越高者、手術前有服用降血壓藥物者手術 期間的血壓較穩定。

三、研究對象的性別、年齡、身體質量指數(BMI)、手術前服用降血壓藥 物情形及高血壓家族疾病史等背景變項可以有效預測手術期間的血壓穩 定程度，並可解釋其總變異量之 31.8%，其中以「手術前服用降血壓藥物 情形」為主要的預測變項。結果顯示，研究對象中手術前未服用降血壓 藥物者，手術期間血壓越不穩定。

本研究提出諸多建議，期能對高血壓病人在手術期間血壓穩定程度 有所助益。Abstract This study aimed to identify factors that affect intraoperative blood pressure in hypertensive patients receiving laparoscopic cholecystectomy at a medical center, using retrospective chart-review method. The perioperative medical records of all hypertensive patients who received laparoscopic cholecystectomy over 18 months (January 2016 to June 2017) was examined, with the following results:

1. A total number of 325 patients were eligible and selected for data processing and statistical analysis. Of all the patients in this study, the male (n=167) to female (n=158) ratio was 1.057. 75% of patients (n=245) were in the age range of 50 to 79 years old. 67% of patients were overweight or obese. 59.4% of patients administered antihypertensive drugs before surgery. Nearly half of the patients had a family history of hypertension. In total, 38.5% of patients developed intraoperative blood pressure instability.

2. Risk factors of ‘age’, ‘body mass index’ and ‘administration of anti-hypertensive drugs before surgery’ were found to influence blood pressure during surgery. The more advanced the age, the more unstable the blood pressure during surgery. In contrast, higher body mass index and those who received anti-hypertensive drugs resulted in more stable intraoperative blood pressure.

3. Background variables such as gender, age, body mass index, status of anti-hypertensive drugs taken before operation, and family history of hypertension can help predict blood pressure stability during surgery (R 2= 0.318). Amongst the background variables, status of anti-hypertensive drugs taken before operation was identified as the most significant predictor variable for intraoperative blood pressure stability.

Conclusion: Status of anti-hypertensive drugs taken before operation is a significant predictor for perioperative blood pressure stability. Therefore, patients with long-term hypertension under medication control should be instructed to take anti-hypertensive medications before surgery to help maintain stable perioperative blood pressure.