乌拉地尔对硝普钠控制性降压效应及内分泌激素影响的研究

Effects of urapidil on controlled hypotension induced by sodium nitroprusside and plasma endocrine hormone

目的 观察乌拉地尔对硝普钠控制性降压效应及血浆内分泌激素的影响，探讨两药复合应用的可行性。方法 择期全麻下脑血管手术病人24例，ASAⅠ～Ⅱ级，随机分为硝普钠（Ⅰ组，n=12）和乌拉地尔复合硝普钠（Ⅱ组，n=12）两组。两组病人麻醉诱导和维持方法相同，平均动脉压均降低30％～40％，分别于降压前即刻、降压达预计值时、维持降压30min、停止降压10min时观察降压诱导时间和降压药的用量，监测血流动力学指标，测定血浆肾素活性、血管紧张素Ⅱ、醛固酮和心钠素的水平。结果 Ⅱ组病人降压诱导时间和降压药用量明显低于Ⅰ组（P〈0．05）；Ⅰ组降压后HR增快明显，降压期间出现快速耐药性，停止降压后出现反跳性高血压，与Ⅱ组比较有显著性差异（P〈0．05）；两组病人各时点所测血浆肾素活性、血管紧张素Ⅱ、醛固酮和心钠素水平与降压前比较差异有极显著性意义（P〈0．01），但组间比较无统计学意义（P〉0．05）。结论 乌拉地尔复合硝普钠控制性降压，在一定程度上优于单纯硝普钠降压。

Objective To observe the effects of urapidil on controlled hypotension induced by sodium nitroprusside and plasma endocrine hormone. Methods Twenty-four adult patients,ASA grade Ⅰ-Ⅱ,scheduled for elective craniotomy, were randomly divided into two groups：group I with intravenous nitroprusside infusion （control,n = 12） ,group Ⅱ with intravenous urapidil and nitroprusside infusion（ n = 12）. The MAP was decreased by 30% - 40%, and kept this lower level. The induction time of hypotension and the dosage of sodium nitroprusside for maintaining hypotension were observed. The plasma renin activity （PRA） ,levels of angiotensin Ⅱ （AⅡ）,aldosterone（ALD） and atrial natriuretic polypiptide （ANP） and hemodynamics were measured at pre-hypotension,immediately after hypotension, 30min following hypotension and 10min after discontinuation of sodium nitroprusside respectively. Results As compared with group Ⅰ , the blood pressure in group Ⅱ more easily reduced and maintained, sodium nitroprusside dosage decreased. After the discontinuation of drug, the reflex heart rate augmentation was suppressed, the blood pressure increased steadily, and no rebounding response was observed as well as the rate-pressure product （RPP） value was decreased significantly in group Ⅱ （ P 〈 0.05）. There was not significant change in CVP in both groups after hypotension（P 〉0.05） ,the levels of PRA, A Ⅱ, ALD and ANP both group were significantly different （P 〈 0.05） at various measurement time. Conclusion Urapidil can enforce the hypotensive action of sodium nitroprusside and reduce the incidence of its complications.