乌拉地尔复合美托洛尔在高龄甲状腺手术患者中的应用

The Study of Urapidil Combined with Metoprolol on Thyroidectomy in Elderly Patients

目的评估乌拉地尔复合美托洛尔用于高龄患者颈丛神经阻滞下甲状腺手术心血管反应的安全性和有效性。方法选择我院90例择期行甲状腺次全切除术的患者,随机分为U组(乌拉地尔组),及U-M组(乌拉地尔+美托洛尔组),每组45例。采用-点法行单侧颈深丛+双侧颈浅丛阻滞,当患者出现血流动力学变化时,U组患者静脉注射盐酸乌拉地尔0.25mg/kg,U-M组患者先静注乌拉地尔0.25mg/kg,再缓慢静注美托洛尔0.035mg/kg。观察给药前后平均动脉压(MAP)及心率(HR),收缩压-脉率乘积(RPP)的变化情况。结果两组患者血流动力学变化的发生率分别为48.9%(U组)和44.4%(U-M组),组间差异无统计学意义(P>0.05)。两组患者在给予实验药物后5min,MAP、HR均有不同程度的下降,但U组未能降至正常范围,而U-M组在用药后5min,MAP、HR可迅速降至正常范围,与用药前比较差异有统计学意义(P<0.01),用药15min后,U组中MAP、HR呈不同程度的上升趋势(P<0.01)。而U-M组中MAP、HR仍有所下降,且都能保持在正常值范围内。用药5min后两组RPP都明显下降,与用药前比较有非常显著性差异(P<0.01),但用药15min后U组RPP值明显回升(P<0.01),而U-M组中RPP值仍稳定在正常值(P<0.01),与U组比较差异非常显著。结论与单独使用乌拉地尔相比,选择乌拉地尔复合美托洛尔,能有效的控制血压和心率,更适合用于并存心血管疾病的高龄患者。

Objective Study the safety and efficacy of Urapidil Combined with Metoprolol on thyroid operation in elderly patients. Methods Ninety ASA Ⅰ-Ⅲ, aged 65- 72, undergoing Thyroidectomy on cervial plexum block elderly patients were randomly assigned to two groups. Group U is the control group using plain Urapidil; in group U - M, the concentration of 0. 035mg/kg Metoprolol was used combined with Urapidil. During the operation, MAP, HR and Rpp were monitored. Results Among each group, the incidence of haemodynamics fluctuation is 48.9% （ group U） and 44.4% （ group U - M）. Compared with group U, the decrease of MAP, HR and RPP were more significant and lasting. Conclusion The Urapidil combined with Metoprolol can be used safely on Thyroidectomy in elderly patients. And compared with plain Urapidil, Urapidil combined with metoprolol is more effectively.