高血壓病人施行腹腔鏡膽囊切除手術期間血壓穩定程度相關因素探討

Identifying factors affecting intraoperative blood pressure stability in hypertensive patients receiving a laparoscopic cholecystectomy at a medical center in Taipei, Taiwan

本研究主要目的是針對高血壓病人在手術期間血壓穩定程度及其相關因素作探討。以醫學中心進行腹腔鏡膽囊切除手術的病人為母群體，採病歷回溯方式，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有高血壓病人為樣本，共得有效樣本325人。所得資料以單因子變異數分析、斯皮爾曼等級相關及多元迴歸進行統計分析。分析後得以下結果：描述性統計方面：一、「性別」男性167人（51.4％）；女性158人（48.6％）。二、「年齡」最小28歲、最大90歲、平均61.56歲、（標準差12.22）。三、「身體質量指數」最小為15.4、最大為43.1、平均為25.8、（標準差為3.8）。四、手術前服用降血壓藥物者有193人（59.4％）；手術前無服用降血壓藥物者有132人（40.6％）。五、有高血壓家族疾病史者有161人（49.5％）；無高血壓家族疾病史者有164人（50.5％）。推論性統計方面:：一、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穩定程度越不穩定；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穩定程度越穩定。二、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％，但其中只以「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。根據研究結果建議：一、醫療單位能跨科部合作，落實在手術前服用降血壓藥物的比率。二、建議各醫療單位（如麻醉科或病房）能籌畫此相關衛生教育如播放衛教影片或辦理手術前衛教說明課程，提供要進行手術伴有慢性疾病的病人及家屬能正確使用手術前慢性病用藥。三、進行手術的外科醫師，在開立手術前醫囑時，就分手術前服用降血壓藥物及不服用降血壓藥物兩派，藉由此研究結果提供及再教育醫護人員，讓預計手術的高血壓病人在手術前能服用降血壓藥物，減少手術中血壓不穩定的程度，期能對手術期間血壓穩定有所助益。 This retrospective study aimed to identify factors that affect intraoperative blood pressure, using medical records of 325 patients who received laparoscopic cholecystectomy from January 2016 to June 2017. ANOVA, Spearman's rank correlation coefficient and multiple regression analysis were used, with the following results: 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. Background variables such as gender, age, body mass index, status of antihypertensive drugs taken before operation, and family history of hypertension can help predict blood pressure stability during surgery, accounting for 31.8% of total variance. The status of anti-hypertensive drugs taken before operation was identified as the most significant predictor variable for intraoperative blood pressure stability. Results show that the lack of anti-hypertensive drugs results in greater degree of intraoperative blood pressure stability 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.