压宁定复合硝酸甘油控制性降压在鼻内窥镜手术中的应用

Clinical study of controlled hypotension by both Uropidil and TNG during FESS

目的探讨压宁定复合硝酸甘油控制性降压在鼻内窥镜手术中的可行性,为临床控制性降压提供新方法。方法选择ASAⅠ～Ⅱ级,术前检查无明显异常行鼻内窥镜手术患者30例(25～40岁),全部病例均采用静吸复合全麻,用芬太尼、异丙酚、维库溴胺诱导,异氟醚持续吸入、维库溴胺间断推注维持麻醉。随机分为3组(A:压宁定组,0.4mg/kg,单次静脉注射;B:硝酸甘油组,0.4μg/kg/min,5分钟之内逐渐加量至理想血压;C:压宁定复合硝酸甘油组:压宁定半量0.2mg/kg静脉注射,5分钟后复合硝酸甘油0.1μg/kg/min微泵维持,起效后5分钟调节剂量至理想的血压。全组连续监测心电图和血压。详细记录用药前、用药后5、10、30分钟及手术结束时的血压和心率变化。各组均在手术结束时停用降压药。结果A组静脉注射压宁定后5min、10min、30min,血压降低,与术前相比,差异有显著性,同时心率没有明显的改变;B组静脉输注硝酸甘油后5min、10min、30min,血压降低,与术前相比,差异有显著性,但同时心率明显增快,与术前相比,差异有极显著性;C组静脉同时给予压宁定和硝酸甘油后5min、10min、30min,血压明显降低,与术前相比,差异有极显著性,同时心率没有明显改变。结论压宁定复合硝酸甘油可有效用于控制性降压。

Objective To investigate the effect of Uropidil and TNG during functional endoscopic sinus surgery（FESS）. Methods Thirty patients（ASA Ⅰ～Ⅱ） were divided into Uropidit group （group A, 0.4mg/kg,）, TNG group （group B, 0.4 μg/kg/min in 5min）, both TNG and uropidil group （group C, 0.2mg/kg（uropidil）,0.1 μg/kg/min（TNG） after 5rain） at random. The changes of blood pressure（BP） and heart rate（HR） were recorded in detail in 5,10,15,30 rains. The medicine were not used when the operation finished Results Bp is lower and HR are not different than preoperative in Group A（P〈0.05）, Bp are lower and HR are faster than preoperative in Group B（P 〈0.01） ,Bp is lower and HR are not different than preoperative in Group C（P〈0.01）. Conclusion It is effective to control hypotension by both TNG and Uropichl during FESS.