尼卡地平、乌拉地尔和艾司洛尔对全麻诱导期间压力反射敏感性的影响

Effects of nicardipine,urapidil,and esmolol on baroreflex sensitivity during induction in patients with essential hypertension

目的观察尼卡地平、乌拉地尔和艾司洛尔对原发性高血压(EH)患者全麻诱导期间压力反射敏感性(BRS)的影响。方法全身麻醉下行择期手术EH患者62例,随机分为四组,分别于诱导前2min静注尼卡地平0.5μg/kg(N组,15例)、乌拉地尔0.5mg/kg(U组,16例)、艾司洛尔0.25mg/kg(E组,16例)和生理盐水(C组,15例)。用相同药物进行全麻诱导。于诱导前、插管前即刻,以及插管后5、10、15、20、30min不同时点静注硝普钠50～100μg,使SBP下降15～25mmHg,记录SBP下降期间RR间期的变化,计算BRS。结果N组、U组和C组插管前后各时间点BRS与基础值比较明显降低(P<0.05或P<0.01),N组中各时点BRS又明显低于C组(P<0.05),而E组明显高于C组(P<0.05)。结论全麻诱导可降低EH患者的BRS;尼卡地平可使BRS进一步降低,乌拉地尔则无显著影响,而艾司洛尔则使全麻诱导期的BRS升高。

Objective To investigate the effects of nicardipine, urapidil, and esmolol on baroreflex sensitivity（BRS） in patients with essential hypertension（EH） during induction of general anesthesia. Methods EH patients were divided into four groups, who were given nicardipine 0. 5 μg/kg（group N, 15 cases） , urapidil 0.5 mg/kg （group U, 16 cases）, esmolol 0.25 mg/kg （group E, 16 cases） or normal saline （group C, 15 cases） at 2 min before induction. The induction of general anesthesia was performed with the same drugs. Sodium nitroprusside 50-100 μg was administered to make systolic pressure（SBP） decreased by 15 25 mm Hg at different time points of before induction, before incubation, at 5, 10, 15, 20 and 30 min after intubation. The RR intervel on ECG was recorded and BRS was calculated during hypotensive period. Results BRS was reduced in groups of N, U and C after intubation compared with that before（P〈0.05 or P〈0.01）, which was lower in group N than that in group C, but was higher in group E than that in group C at all time points（P〈0. 05）. Conclusion The induction of general anesthesia may reduce BRS in EH patients,which is aggravated by preinjection of nieardipine. Urapidil has no effect on BRS, but esmolol may increase BRS during induction of general anesthesia.