尼卡地平控制性降压对全麻患者血液动力学的影响

The controlled hypotension effect of nicardipine in patients undergoing elective hip operations

目的评价髋部手术中应用尼卡地平行控制性降压对全麻患者血液动力学的影响。方法择期行髋部手术患者20例,随机分为尼卡地平组(Ⅰ组)、对照组(Ⅱ组),每组10例。在静吸复合全身麻醉下,静脉输注尼卡地平进行控制性降压或不降压完成手术。用经食管超声多普勒血流监测仪监测两组患者的血液动力学变化,术中出血量、输液量、尿量,异体输血情况,以及拔除气管内插管和清醒时间。结果平均动脉压(MAP):Ⅰ组由87mm Hg降至59mm Hg,Ⅱ组由100mm Hg降至71mm Hg;周围血管阻力(TSVRa):Ⅰ组由1355dyn·s/cm5降至761dyn·s/cm5,Ⅱ组由2065dyn·s/cm5降至1429dyn·s/cm5;Ⅱ组的中心静脉压(CVP)也由10.3mm Hg降至5.3mm Hg,两组比较P均<0.05。Ⅰ组与Ⅱ组比较,术中MAP更低(60mm Hg vs 80 mm Hg),但停用尼卡地平后两组相似(80mm Hg左右)。主动脉血流量(ABF)、心输出量(CO)在降压组并不降低,反而趋于升高(ABFⅠ组由3.7L/min渐至4.9L/min,Ⅱ组始终在2.8L/min左右),P<0.05。血液回吸收量相似[Ⅰ组(577±389)ml,Ⅱ组(423±221)ml],P>0.05。Ⅰ组患者尿量稍多(600ml vs 162ml),P<0.05。拔管时间和清醒时间Ⅱ组比Ⅰ组明显缩短(13min vs 28min,19min vs34min),P<0.05。结论尼卡地平可以安全地用于全身麻醉患者控制性降压,但未证明能更好地减少术中出血。

Objective To investigate the controlled hypotension effect of nicardipine on hemodynamics of patients undergoing hip operation. Methods Twenty ASA Ⅰ-Ⅱ patients scheduled for replacement of total hip or open reduction and internal fixation for fracture of acetabulum were randomly divided into two groups. Their age ranged between 20-70 years with body-weight of 50-80 kg. One group of patients was given nicardipine（group Ⅰ ）for hypotention induction during operation. The other group serves as the controls （group Ⅱ ）. Each group had ten patients included. Anaesthesia was maintained with isoflurane and intravenous drugs. The mean arterial blood pressure was reduced to 55-65 mm Hg with 1- 8 μg/kg ,min nicardipine. ABF,CO,SV,PV,Acc,LVETi,TSVR and D were recorded respectively at before hypotension （To）, 15 min,30 min, 60 min after hypotension（T1,T2,T3） was initiated and 15 min,30 min after recovery from hypotension（T4,T5） in both groups. Intraoperative blood loss volume, transfusion,urine volume and the time of extubation and consciousness recovery time were measured at the same time. Results Systemic circulatory resistance reduced significantly （P〈0.05）in both groups. The MAP was evidently lowered （P〈0.05 and systemic circulatory resistance was significantly （P〈0.05）depressed with nicardipine. Furthermore, the aorta blood flow and cardiac output tended to increase or unchange during hypotention with nicardipine. The stroke volume ,left venticular ejection time,Acc and D were changed mildly compared to the pre-operation values （P〉0.05）. The intraoperative blood loss and transfusion were not significantly different between the two groups. But the urine volume was much less in group Ⅱ. Conclusions Nicardipine can significantly reduce systemic circulatory resistance, but cardiac output tends to increase. It can be used safely to induce controlled-hypotension with no significant effect on hemodynamics. There is no evidence that controlled hypotension with nicardipine can decrease blood loss in operation.