复合用药控制性降压在颅脑手术的应用

Application of combined drugs in controlled hypotension for craniocerebral operations

目的比较单独用硝酸甘油与硝酸甘油加艾司洛尔,在颅脑手术时行控制性降压的效果。方法34例在异氟烷全麻下行颅脑手术病人,随机分为硝酸甘油组(Ⅰ组,16例)和硝酸甘油复合艾司洛尔组(Ⅱ组,18例),术中MAP降至并维持在60～65mmHg,观察此降压期间血流动力学的变化。结果1.两组各行控制性降压时间无显著差异。2.Ⅱ组硝酸甘油平均用量和总用量比Ⅰ组分别减少42%和39%(P<0.05)。3.Ⅰ组降压后心率明显增快(P<0.05)。Ⅱ组合并使用艾司洛尔50μg·kg-1·min-1后,心率变化不大,各时段心率均慢于Ⅰ组(P<0.01)。4.两组降压所需时间和停降压药后血压回升时间无显著差异(P>0.05)。结论异氟烷全麻下的颅脑手术患者,术中行控制性降压至MAP60～65mmHg,如联合应用硝酸甘油和艾司洛尔,可显著减少硝酸甘油的用药量,并可避免降压过程中的心率增快,使降压过程确切、满意。

Objective To compare the effect of using simple nitroglycerin(group Ⅰ) with nitroglycerin plus esmolol(group Ⅱ) for controlling hypotension during craniocerebral operations. Methods 34 cases received general anesthesia with isoflurane for craniocerebral operations were randomly divided into group Ⅰ(16 cases)and groupⅡ(18 cases).MAP was declined and maintained to 60～65mmHg during operation and hemodynamic change was observated during hypotensive period.Results 1.There was no significant difference between the two groups in controlling hypotensive time.2.In the everage dose and total dose of nitroglycerin,the group Ⅱ was less than that group Ⅰ in 42% and 39% respectively(P< 0 05). 3. The heart rate was increased apparently after hypotension in group Ⅰ(P < 0 05).The heart rate was no difference after combined use esmolol 50μg /kg/min in groupⅡ,and it′s heart rate of every periods were lower than that groupⅠ(P< 0 01).4.Needed time of hypotension and rising time of blood pressure after discontinuous hypotensive drugs were no obvious difference between the two groups(P >0 05). Conclusions Under general anesthesia with isoflurane to perform the craniocerebral operation,the controlling hypotension was declined to MAP within 60～65mmHg.If combined use nitroglycerin and esmolol,it can obviously reduce the dose of nitroglycerin and avoid the increase of heart rate during the hypotensive course.The effect of hypotensive course is affirmative and satisfactory.