美托洛尔对高血压非心脏手术病人的干预研究

The Study of Metoprolol Intervention in Patients with Hypertention Undergoing Non-cardial Surgery

目的:研究美托洛尔诱导前和拔管前静脉给药对高血压非心脏手术病人循环及心肌钙蛋白I(CTnI)的影响,并借此评价美托洛尔的心肌保护作用。材料和方法:选择期手术病人38例,随机分为2组,对照组和实验组。实验组在诱导前和拔管前静脉注射美托洛尔(0.04mg/kg),对照组给予生理盐水。记录诱导前、插管期间、切皮和拔管期间的收缩压、舒张压、心率。观察整个手术期间心电图、分析S-T段。心肌钙蛋白I在诱导前和手术结束后各抽静脉血测之。结果:美托洛尔组的收缩压和心率在插管期间、切皮和拔管期间都低于对照组(P<0.05),有显著性差异。舒张压在切皮和拔管期间显著低于对照组(P<0.05)。对照组有3例在插管期间出现S-T段压低,美托洛尔组没有,但组间比较无显著差异(P>0.5)。心肌钙蛋白I,美托洛尔组在术毕时明显低于对照组(P<0.05),有显著性差异。结论:在诱导前和拔管前静脉注射β受体阻滞剂美托洛尔对高血压择期非心脏手术病人有心肌保护作用。

Objective We studied the effects of metoprolol infusion before induction and extubation on cardiac troponin Ⅰ and blood circulation of patients with hypertention undergoing elective noncardial surgery, with which assess cardio-protective effects of metoprolol. Methods Thirty eight patients were randomized to divide into two groups, group metoprolol and control, which were infused metoprolol（0.04 mg/kg） and physiological saline（placebo） respectively before induction and extubation. Systolic diaslolic ,heart rate and electrocardiogram （lead Ⅱ） were moniterred during anesthesia and operation. But we noted the parameters at four time points, before induction, during tracheal intubation, incision and extubation. Continuous real-time S-T segment trend monitering and analysis （lead Ⅱ） was performed during anesthesia and surgery. Cardiac troponin Ⅰ was detected by drawing venous blood samples before induction and after surgery. Results Systolic and heart rate in metoprolol group descended more significantly than in placebo group during intubation, incision and extubation （P〈0.05）. Diaslolic dropped more significantly in metoprolol than in control during incision and extubafion （P〈0.05）. There were three patients in control with S-T segment depression during endotracheal intubation, while there were no one in meto prolol group, which is not significant （P〉0.5）. Cardiac troponin I in control increased more significantly than in metoprolol group （P〈0.05）.Gonclusion Infusion metoprolol before induction and extubation can reduce partly myocardial ischemia damage and have cardio-protective effects during anesthesia and surgery for patients with hypertension.