尼卡地平联合硝酸甘油降压在颅脑手术中的应用

Application of nicardipine combined with nitroglycerine induced hypotension in craniocerebral operations

目的观察尼卡地平联合硝酸甘油控制性降压对血流动力学、脑氧供需平衡及肾功能的影响。方法45例ASAⅠ～Ⅱ级择期行颅脑手术病人，随机分为三组：Ⅰ组为尼卡地平联合硝酸甘油降压组，Ⅱ组为硝酸甘油降压组，Ⅲ组施行颅脑手术未行降压的对照组。Ⅰ组、Ⅱ组降压以平均动脉压（MAP）基础值的60％～70％持续至手术重要步骤结束，Ⅲ组未行降压。连续监测MAP、心率（HR）、最小肺泡气浓度（MAC），并同步采集桡动脉和颈内静脉血行血气分析，计算动-颈内静脉氧含量差（Da—jvO2）和脑氧摄取率（ERO2），并测定血浆β2-微球蛋白（β2-MG）。结果Ⅰ组降压后血流动力学稳定，Da—jvO2和ERO2下降；Ⅱ组血流动力学波动明显，ERO2、Da—jvO2显著增加；组内比较差异无统计学意义（P〉0．05）；组间比较差异有统计学意义（P〈0．05），三组β2-MG均无明显升高，组内、组间比较差异均无统计学意义（P〉0．05）。结论尼卡地平联合硝酸甘油控制性降压对血流动力学的影响小，不影响脑组织氧供并对脑组织有保护作用，比单纯用硝酸甘油降压更安全；并且对肾功能也无明显影响。

Objective To observe the effects of nicardipine combined with nitroglycerine induced hypotension on haemodynamics and the balance of cerebral oxygen supply and consumption and renal function. Methods Forty- five ASA Ⅰ - Ⅱ patients （18 -60 years）undergoing elective craniocerebral operations were divided into three groups. Group Ⅰ： nicardipine combined with nitroglycerine induced hypotension;group Ⅱ： nitroglycerine induced hypotension; group Ⅲ： uncontrolled hypotension. In group Ⅰ and Ⅱ, MAP was decreased to 60% - 70% of baseline, and was kept for the end of operation of significant step either by nicardipine combined with nitroglycerine or by nitroglycerine infusion. MAP, HR, MAC were monitored continuously, and radial arterial blood samples and jugular blood samples were taken synchronously for measuring blood gas and β2 - MG level. Results In group Ⅰ during induced hypotension haemodynamics stabilized,ERO2, Da - jvO2 showed reduction,but in group Ⅱ haemodynamics fluctuated significantly, ERO2, Da- jvO2 showed increased significantly. There were significant differences interclass with regard to ERO2, Da - jvO2 （ P 〈 0.05 ）. There was no significant increased in β2 - MG level in three groups （ P 〉 0.05 ）. Conclusion The nicardipine combined with nitroglycerine induced hypotension haemodynamics stabilize, has no adverse effect on cerebral oxygen balance and the cerebral perfusion. Nicardipine combined with nitroglycerine can saftly applied to controlled hypotension during cerebral neurosystem. There is no adverse effect on renal function in three groups.