体外循环中尼卡地平和硝酸甘油控制血压效果及对血流动力学参数的影响

A COMPARISON OF EFFECTS OF NICARDIPINE AND NITROGLYCERIN ON THE BLOOD PRESSURE AND HEMODYNAMICS DURING EXTRACORPOREAL CIRCULATION

目的比较尼卡地平和硝酸甘油在体外循环中控制高血压效果及对血流动力学参数的影响。方法40例双瓣膜置换病人在体外循环（CPB）中平均动脉压（MAP）升至10．67kPa时给予尼卡地平（尼卡地平组）或硝酸甘油（硝酸甘油组）治疗。观察两药起效时间，维持MAP在6．67～9．33kPa时所需剂量，开放升主动脉后心脏自动复搏情况以及停机后血流动力学参数变化。结果尼卡地平组将MAP从10．67kPa降至6．67～9．33kPa的时间及维持MAP在6．67～9．33kPa的剂量与硝酸甘油组比较，差异有显著性（t=6．63、10．00，P〈O．05）。尼卡地平组有17例（85％）、硝酸甘油组有9例（45％）在开放升主动脉后心脏自动复搏，尼卡地平组自动复搏率明显高于硝酸甘油组（x^2=7．03，P〈O．05）。结论CPB中尼卡地平较硝酸甘油降压明显，对血流动力学参数影响较小。

Objective To compare the effects of nicardipine and nitroglycerin on blood pressure and hemodynamics during extracorporeal circulation. Methods This study was carried out in 40 patients undergoing double valve replacement. Nicardipine （Group Ⅰ ） or nitroglycerin （Group Ⅱ ） was administered when mean arterial pressure （MAP） reached 10.67 kPa during the procedures. The onset and dosage required for maintaining MAP at 6. 67-9. 33 kPa were recorded. The hemodynamic parameters were monitored before and after extracorporeal circulation. Results For the Group Ⅰ , the time and dosage to reduce MAP from 10. 67 kPa to 6.67-9.33 kPa and the dosage to maintain MAP at 6.67-9.33 kPa were significantly different from those of group Ⅱ （t=6.63,10.00; P〈0.05）. More patients in group Ⅰ （n=17, 85%） than those in group Ⅱ （n=9, 45%） restored spontaneous heart beat following the release of aortic cross clamp. The difference between the two groups was significant （x^2= 7.03, P〈0.05）. Conclusion Comparing with nitroglycerin, nicardipine shows more advantages in the treatment of hypertension during extracorporeal circulation and less influence on hemodynamics.