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小儿高血压的围手术期管理

Perioperative Management of Paediatric Hypertension.

作者信息

Barbosa Nicole, Redelinghuys Cara, Mogane Palesa

机构信息

Department of Anaesthesia, School of Clinical Medicine, Charlotte Maxeke Johannesburg Academic Hospital University of the Witwatersrand, Johannesburg 2193, South Africa.

Department of Anaesthesia, School of Clinical Medicine, Chris Hani Baragwaneth Academic Hospital, University of the Witwatersrand, Johannesburg 1864, South Africa.

出版信息

Children (Basel). 2025 Sep 3;12(9):1174. doi: 10.3390/children12091174.

Abstract

Paediatric hypertension presents significant perioperative challenges due to its variable aetiology and potential for end-organ damage. The prevalence varies with age and is associated with both primary and secondary causes, which differ markedly from adult hypertension. This review outlines the classification, diagnosis, and causes of paediatric hypertension to provide context for its management in the perioperative setting. Emphasis is placed on the identification and preoperative optimisation of hypertension, intraoperative blood pressure control, and the management of hypertensive crises. Specific perioperative strategies, including anaesthetic planning, pharmacological interventions, and postoperative monitoring, are discussed. Specific conditions such as phaeochromocytoma and aortic coarctation require tailored pharmacological strategies and close interdisciplinary collaboration. Postoperative care in an intensive care setting is essential for monitoring complications and achieving long-term blood pressure control. Effective perioperative management of paediatric hypertension requires early identification, thorough preoperative assessment, and prompt intraoperative and postoperative intervention. Multidisciplinary care and an understanding of paediatric specific pathophysiology are key to reducing morbidity and improving outcomes.

摘要

小儿高血压因其病因多样以及存在终末器官损害的可能性,在围手术期带来了重大挑战。其患病率随年龄而异,与原发性和继发性病因均相关,这与成人高血压有显著不同。本综述概述了小儿高血压的分类、诊断及病因,为其围手术期管理提供背景信息。重点在于高血压的识别与术前优化、术中血压控制以及高血压危象的管理。讨论了具体的围手术期策略,包括麻醉规划、药物干预及术后监测。诸如嗜铬细胞瘤和主动脉缩窄等特定情况需要定制的药物策略及密切的多学科协作。在重症监护环境下进行术后护理对于监测并发症和实现长期血压控制至关重要。小儿高血压的有效围手术期管理需要早期识别、全面的术前评估以及及时的术中及术后干预。多学科护理以及对小儿特定病理生理学的理解是降低发病率和改善预后的关键。

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