静注卡托普利对腹腔镜手术心血管反应的影响

Effects of Intravenous Captopril on Cardiovascular Responses during Laparoscopic Surgery

目的观察了静脉注射卡托普利(captopril)对腹腔镜手术气腹建立时心血管反应的影响。方法择期腹腔镜胆囊切除术患者52例,男22例,女30例,ASA分级为Ⅰ～Ⅱ级,年龄26～60岁,随机分为两组:对照组和卡托普利组,每组26例。麻醉诱导依次静脉注射咪唑安定0.1mg/kg、芬太尼2μg/kg、依托咪酯0.3mg/kg和维库溴铵0.1mg/kg。在气腹建立前10min,卡托普利组经静脉注射卡托普利0.4mg/kg,对照组静脉注射同容量的生理盐水。两组均与充气前15min(T0)、充气腹内压达预定值时1min(T1)、5min(T2)和10min(T3)抽取血样,采用放射免疫法测定血浆肾素活性(PRA)和血管紧张素Ⅱ(AⅡ),持续监测患者的血压(HR)、收缩压(SP)、舒张压(DP)和平均动脉压(MAP),并计算心率收缩压乘积(RPP)。结果对照组充气后患者的HR、SP、DP、MAP和RPP较充气前明显升高(P<0.01),卡托普利组充气后心血管反应轻微,两组充气后血流动力学的比较,差异有非常显著的意义(P<0.01);两组PRA和AⅡ的血浆水平相比较差别也有非常显著意义(P<0.01)。结论卡托普利能有效地预防腹腔镜二氧化碳(CO2)气腹建立期间的心血管反应。

Objective To observe the effects of intravenous captopril on the cardiovascular responses to intraperitoneal insufflation of carbon dioxide during laparoscopic surgery. Methods Fifty-two ASA Ⅰ -Ⅱ patients （aged 26-60 years） scheduled for elective laparoscopic cholecystectomy were randomly divided into two groups： control group （n=26） and captopril group （n=26）. The patients received normal saline in control group and captopril 0.4mg/kg in captopril group 10 min before intraperitoneal insuffflation of carbon dioxide. HR.SP.DP and MAP of all patients were continuously monitored Blood samples were collected 15 min before insufflation of carbon dioxide （T0） ; 1 min （T1） .5min （T2） and 10 min （T3） after goal intra-abdominal pressure obtained, plasma renin activity （PRA） and angiotensin Ⅱ （A Ⅱ ） were assaied with radioimmunassay. Results During intraperitoneal insufflation of carbon dioxide ,in control group, HR.SP.DP.MAP and RPP of patients were significantly increased as compared with the T0 （P〈0.01）,while in captopril group, these parameters either remained unchanged or increased only slightly.There were significant difference in cardiovascular responses and plasma level of PRA and A Ⅱ between the two groups （P〈0.01） after the pneumoperitoneum was estabished. Conclusion Captopril may be effectively attenuate the cardiovascular responses to intraperitoneal insufflation of carbon dioxide during laparoscopic surgery.