硝普钠-佩尔地平在颅内动脉瘤血管内治疗术中控制性降压效果的对比研究

Study of Effects of Sodium Nitroprusside, Sodium Nitroprusside-perdipine and Perdipine on controlled Hypotension during Endovascular Treatment in Patients with Intracranial Anevrysms

目的比较研究硝普钠、佩尔地平或佩尔地平和硝普钠联合用于血管内介入治疗术中控制性降压对血流动力学的影响并探讨其可行性。方法45例Hunt-Hess分级为0～Ⅱ级的颅内动脉瘤患者,在持续异丙酚静脉镇静下行血管内介入治疗,采用硝普钠、佩尔地平或佩尔地平和硝普钠联合控制性降压至平均动脉压70～80mmH只,降压前后及降压期间监测血压、心率、心电图、脉搏血氧饱和度及血气和乳酸变化。结果硝普钠控制性降压起效快,术中可控性强,但在降压初期须调整给药速度,于放射性特殊环境下不利于病情观察,存在一定难度;佩尔地平降压起效相对较慢,可控性相对较差,停止降压后血压回升较慢;而佩尔地平和硝普钠联合降压效果确切,降压过程平稳易调控。结论佩尔地平联合硝普钠控制性降压效果确切,减少了调整给药速度的次数,术中可控性强,介入治疗放射性环境下联合用药优于单纯使用硝普钠或佩尔地平降压。

Objective To compare the effects of sodium nitroprussid（ SNP）, SNP-perdipine and perdipine on the controlled hypotension. Methods Forty-five patients with intracranial aneurysms, whoes conditons were Hunt-Hess 0 ～Ⅱ, were randomly divided into three groups. The endovascular treatment was performed under the conscious sedation induced whith intravenous infusion of propofol in all the patieats of three growps. The controlled hypotension was induced respectively by intravenous infusion of SNP, SNP-perdipine and perdipine in the tree groups during the endovascular treatment. The radial artery pressure and mean arterial pressure the（MAP） of dorsal artery of the left foot, heart rate, ECG, saturaion of blood oxygen, the arterial blood gas analysis and blood lactic acid were monitored before, after and during the controlled hypotension. Results SNP induced the controlled hypotension faster and better than perdipine did. However it was difficult for anesthetist to observe the patient＇s condition and the speed of administration of SNP was necessitously adjusted at initial stage of hypotension in radioactivity environment when the controlled hypotension was induced by SNP. The MAP rised slowlier after the hypotension induced by perdipine than that by SNP. The hypotension induced by intravenous SNP-perdipine was better and more controllable than that by SNP or perdipine. Conclusions THe effect of SNP-perdipine on the controlled hypotension better and more controllable, and the frequency of adjusting the speed of administration was decreased in the radioactivity environment. Intravenous infusion of SNP-perdipine was better than SNP and perdipine for the controlled hypotension in the patients undergoing endovascular treatment.