可乐定对鼻内镜术中小剂量肾上腺素浸润注射所致低血压的影响

Clonidine pretreatment ameliorates epinephrine-induced hypotension during functional endoscopic sinus surgery

目的鼻内镜术中小剂量肾上腺素浸润注射可引起短暂明显的低血压,文中观察可乐定对低血压的预防效果。方法 40例在全身麻醉下行鼻内镜术患者随机均分为可乐定组和对照组,分别在全身麻醉诱导前30 min缓慢静脉注射可乐定2μg/kg或等容等渗盐水。手术前鼻腔局部浸润注射含20μg(5μg/ml)肾上腺素的1%利多卡因4 ml。采用阻抗心动图记录浸润注射前和浸润注射后1.5、3.0、4.5、6.0min的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、心脏指数(cardiac index,CI)和外周血管阻力指数(systemic vascular resistance index,SVRI)。结果与基础值比较,2组在浸润注射后1.5 min均出现MAP、SVRI下降和HR、CI升高(P<0.05),可乐定组于3.0 min后MAP、SVRI、HR和CI均恢复至基础值水平,而对照组在4.5和6.0min时除HR外,其余3个指标仍未恢复(P<0.05)。结论麻醉诱导前静脉注射可乐定可缓解小剂量肾上腺素浸润注射所致低血压。

Objective Infiltration with epinephrine-lidocaine solution in patients undergoing functional endoscopic sinus surgery(FESS) may result in transient but significant hypotension.This study was to determine whether clonidine pretreatment could attenuate this fall in mean arterial pressure(MAP).Methods Forty patients undergoing elective FESS under general anesthesia were equally randomized into a clonidine and a control group,the former injected intravenously with clonidine at 2 μg/kg,and the latter with equal volume of saline 30 minutes before induction of anesthesia.All the patients received local nasal infiltration of 4 mL of lidocaine(1%) containing 20 μg of epinephrine(5 μg/mL).Hemodynamic values were monitored by impedance-cardiogram(ICG),and MAP,heart rate(HR),cardiac index(CI) and systemic vascular resistance index(SVRI) were recorded before and 1.5,3.0,4.5 and 6.0 min after the infiltration.Results Compared with the baseline,MAP and SVRI decreased whereas CI and ACI increased in both groups(P<0.05) at 1.5 min after the infiltration.MAP,SVRI,HR and CI returned to the baseline levels at 3.0 min in the clonidine group,but none of the parameters except HR did in the control group even at 6 min after the infiltration(P<0.05).Conclusion Intravenous injection of clonidine before induction of anesthesia may ameliorate epinephrine-induced hypotension during FESS.