异氟醚在高血压肿瘤病人术中最佳降压幅度的探讨

Best Amplitude of Hypotensive Isoflurane in Tumor Patients Complicating Hypertension

观察了２９例ＡＳＡⅡ、Ⅲ级高血压肿瘤病人应用异氟醚行控制性降压前后的血流动力学和ＥＣＧ变化。结果发现，当ＭＡＰ降至基础值的９０％时，ＳＩ、ＴＰＲ、ＶＰＥ、ＨＯＩ、ＣＰＰ有所改善，但外周阻力仍高，心肌耗氧量仍大。当ＭＡＰ降至基础值的６０％时，ＳＩ、ＴＰＲ、ＨＯＩ、ＣＰＰ均达正常范围，但ＶＰＥ低于正常值，且ＥＣＧ监测发现有９０％病例出现ＳＴ段下移。观察结果表明，当ＭＡＰ降至术前值的７０％～８０％时，使高血压肿瘤病人心血管系统在ＳＩ、ＣＩ、ＴＰＲ、ＨＯＩ、ＶＰＥ、ＣＰＰ等方面的相对平衡中达到最佳的功能状态及最小的负荷，这对高血压肿瘤病人是异氟醚降压中最适合降压的幅度。

Twenty nine hypertension tumor patients,ASA class Ⅱ to Ⅲ,were selected as subjects.The changes of hemodynamics and ECG were observed before and after controlled hypotension with isoflurane.The results showed that SI,TPR,VPE,HOI and CPP were improved when MAP was reduced to ninty percent of basic value.But the peripheral resistence and myocardial oxygen consumption were high still.The values of SI,TPR,VPE,HOI and CPP were at normal range when MAP was reduced to sixty percent of basic value.But the value of VPE was lower than normal one and ST segment moved down in ninty percent of patients.When MAP was reduced to eighty,to seventy percent of basic value,the values of SI,CI,TPR,HOI,VPE and CPP were optimal and the best cardiovascular function was reached.