硝酸甘油复合艾司洛尔在经DSA行颅内动脉瘤栓塞术中控制性降压的研究

Clinical study of combined nitroglycerin with esmolol for the deliberate hypotension during the embolization of the intracranial aneurysm under DSA

目的观察硝酸甘油复合艾司洛尔用于经数字减影血管造影（DSA）行颅内动脉瘤栓塞术中控制性降压的可行性。方法选择32例颅内动脉瘤行电解可脱性弹簧圈（GDC）栓塞术的患者,随机分为两组：A组为硝酸甘油组;B组为硝酸甘油复合艾司洛尔组。每组各16例。结果B组术中心率（HR）及心肌耗氧量（RPP）值明显低于A组（P〈0.01）;B组术中硝酸甘油的用药量明显低于A组（P〈0.01）;A组术中有2例动脉瘤破裂改行开颅手术,而两组术后均未见明显的心脑栓塞、苏醒延迟等并发症。结论硝酸甘油复合艾司洛尔可安全有效地应用于经DSA行颅内动脉瘤GDC栓塞术中控制性降压。

Objective To observe the feasibility of combined nitroglycerin with esmolol for the deliberate hypotension during the embolization of the intracranial aneurysm under digital subtraction angiography（DSA）. Methods Thirty-two ASA Ⅱ-Ⅲ patients scheduled for the guglielmi detachable coil embolization of the intracranial aneurysm were divided randomly and averagely into two groups：group A was nitroglycerin group,group B was combined nitroglycerin with esmolol group. General anesthesia were performed in two groups. MAP,HR,SpO2,ECG and PETCO2 were observed and recorded at the different time points. RPP（SBP×HR）and nitroglycerin dosage were calculated at the same time points. Results HR and RPP in group B were significantly lower than those in group A during the operation （P〈0.01）,nitroglycerin dosage in group B was significantly lower than that in group A（P〈0.01）,cardiac cerebral embolization and delayed recovery were not found after operation. Conclusion The combined nitroglycerin with esmolol was a feasible technique for the deliberate hypotension during the guglielmi detachable coil embolization of the intracranial aneurysm under DSA.