尼卡地平并美托洛尔对颅内动脉瘤夹闭术降压效果

EFFECT OF NICARDIPINE COMBINED WITH METOPROLOL IN LOWERING BLOOD PRESSURE DURING INTRACRANIAL ANEURYSM SURGERY

目的观察尼卡地平联合美托洛尔用于颅内动脉瘤夹闭术中的降压效果和安全性。方法将56例颅内动脉瘤择期手术病人（ASAⅡ～Ⅲ级）随机分为两组,乌拉地尔联合硝酸甘油组（Ⅰ组,28例）在诱导前2 min静脉注射乌拉地尔0.2 mg/kg、硝酸甘油2μg/kg,插管后5 min用微量泵输注乌拉地尔2μg/（kg.min）、硝酸甘油0.5μg/（kg.min）;尼卡地平联合美托洛尔组（Ⅱ组,28例）在诱导前2 min静脉注射尼卡地平15μg/kg,美托洛尔20μg/kg,插管后5 min用微量泵输注尼卡地平2μg/（kg.min）、美托洛尔4μg/（kg.min）。观察两组诱导前、插管后2 min、插管后10 min、夹闭动脉瘤时、手术结束时心率（HR）、收缩压（SBP）、舒张压（DBP）和平均动脉压（MAP）的变化。结果Ⅰ组插管后较诱导前SBP、MAP、DBP均明显降低,而HR则明显增快,差异有显著性（F=6.147～10.142,P〈0.05、0.01）。Ⅱ组插管后SBP、MAP、DBP、HR较诱导前均明显降低,差异有显著性（F=7.247～18.136,P〈0.01）。Ⅱ组HR明显低于Ⅰ组（t=7.28,P〈0.01）。结论尼卡地平联合美托洛尔用于颅内动脉瘤夹闭术中降压安全有效,并能增加降压期间重要器官的灌注和维持循环功能的稳定。

Objective To observe pressure-lowering effect and safety of Nieardipine combined with Metoprolol in surgery of intracranial aneurysm. Methods Fifty six patients with intracranial aneurysm （ASA Ⅱ -- Ⅲ ） scheduled for selective surgery were divided into Urapidil-plus-nitroglycerin group （group Ⅰ ） ： iv Urapidil 0.2 mg/kg and iv nitroglycerin 2 μg/kg were given two minutes before anesthesia induction, and Urapidil 2 μg/（kg · min）, nitroglycerin 0.5 μg/（kg · min） were given via a micro pump five minutes after tracheal intubation; Nicardipine-plus-metoprolol group （group Ⅱ ） ： iv Nicardipine 15 μg/kg and metoprolol 20 μg/kg were injected two minutes before induction, and nieardipine 2 μg/（kg · min）, metoprolol 4 μg/（kg · min） were injected via a micro pump five minutes after intubation. The heart rate （HR）, systolic pressure （SP）, diastolic pressure （DP）, and mean arterial pressure （MAP） were measured before induction, two and 10 minutes after intubation, at clamping aneurysm and at the end of operation. Results In group Ⅰ , SP, DP and MAP were much lower after intubation than that before induction, but HR significantly faster （F=6. 147-10. 142;P〈0.01,0.05）. In group Ⅱ , all the parameters decreased compared with those before induction （F=7. 247-18. 136,P〈0.01）. The HR in group Ⅰ was slower than that in group Ⅱ （t=7.28,P〈0.01）. Conclusion The combination of Nicardipine and Metoprolol to step down the blood pressure during intracranial aneurysm surgery is effective and safe, which can increase hemoperfusion of critical organs and stabilize blood circulation.