艾司洛尔和硝普钠控制性降压对鼻内窦手术病人血利尿钠肽的影响

Study on esmolol and sodium nitroprusside's hypotension control on atrial and brain natriuretic peptide in patients undergoing endonasal sinus surgery

目的研究控制性降压对鼻内窦术病人血浆心房利尿钠肽（ANP）和脑利尿钠肽（BNP）水平的影响。方法选择45例无心血管疾病拟实行鼻内窦术病人随机分成三组，每组15例即控制性降压艾洛尔组和硝普钠组平均动脉压（MAP）维持在50-55mmHg；对照组平均动脉压维持在70～80mmHg。在下列各时点测定血ANP和BNP浓度：术前（T1）、手术结束时（T2）、2h（T3）、24h（T4）、48h（T5）。结果术前ANP和BNP水平均在正常范围并且三组水平均相似，与对照组（ANP5．31±2．32ug／ml；BNP13．26±8．98ug／ml，P〈0．01）相比艾司洛尔组（ANP2．46±0．75ug／ml；BNP4．34±3．06ug／m1）和硝普钠组（ANP2．48±0．92ug／ml；BNP4．49±3．21ug／m1）T2，T3时点ANP和BNP浓度均下降，并且失血量减少和手术时间缩短。结论控制性降压减少心血管健康病人利尿钠肽的释放。这种作用是通过降低全身阻力和灌注压引起心室充盈压下降引起而实现。

Objective The study was designed to assess serum concentration of atrial and brain natriuretic peptide in patients undergoing endonasal sinus surgery under controlled hypotension. Methods We studied 45 patients without cardiovascular history, scheduled for elective endonasal sinus surgery. Patients were allocated to one of three groups： controlled hypotension was induced either by using esmolol （n=20） or sodium nitroprusside （ n = 20） with a mean arterial pressure of 50-55 mmHg. In the control group （ n = 20）, mean arterial pressure was adjusted to 70-80 mmHg. Atrial and brain natriuretic peptides（ANP,BNP）were measured preoperatively （T1）, at the end of surgery （T2）, 2h （T3）, 24 h （T4） and 48 h （T5） pestoperatively. Results Preoperative atrial and brain natriuretic peptide plasma levels were within normal ranges and similar between all groups. Patients treated with esmolol （ANP：2.46±0.75 ug/ml; BNP： 4.34±3.06 ug/ml） and sodium nitropusside （ANP： 2.48± 0.92 ug/ml;BNP： 4.49±3.21 ug/ml ） showed significantly lower concentrations of atrial and brain natriuretic peptide at T2 and T3 compared with controls （ANP： 5.31±2.32 ug/ml; BNP： 13.26±8.98 ug/ml, P 〈 0.01 ） as well as a reduction in blood loss and duration of surgery. Conclusion Controlled hypotension decreases the release of natriuretic peptides in cardiovascular healthy patients. This effect may be contributed by changes in cardiac filling pressure due to lower systemic resistance and diminished perfusion pressure.