乌拉地尔用于正颌手术控制性降压的效果评价

Clinical evaluation of controlled hypotension of urapidil in orthognathic surgery

目的:观察乌拉地尔在正颌手术控制性降压中的应用效果。方法:选取正颌手术患者40例,ASAⅠ～Ⅱ级。随机分为2组,U组(乌拉地尔复合异丙酚组20例)和P组(异丙酚组20例)。麻醉诱导,2组都给予咪达唑仑0.05mg/kg、芬太尼2μg/kg、异丙酚2mg/kg、罗库溴铵0.8mg/kg行麻醉诱导插管。2组均由2%七氟烷和异丙酚维持麻醉。U组在异丙酚的基础上复合乌拉地尔行控制性降压。P组仅用异丙酚行控制性降压。2组都以平均动脉压(MAP)维持在60～65mmHg为目标。记录2组在诱导前后及降压前后各个时间段的心率(HR)、收缩压(SBP)、舒张压(DBP)及MAP的值,并进行比较,同时根据Fromme术野评分表评定手术视野质量。采用SPSS11.0软件包进行统计学分析。结果:控制性降压期间,2组MAP都低于术前(P<0.01)。U组在5、10、20min的MAP显著低于P组(P<0.01)。U组的术野评分也优于P组(P<0.01)。但两组心率都有增高,差异不显著(P>0.01)。结论:乌拉地尔用于正颌手术控制性降压安全有效,起效迅速,可使术野质量更加清晰。

PURPOSE： To evaluate the effect of controlled hypotension by urapidil in oral maxillofacial orthognathic surgery. METHODS： Forty ASA Ⅰ or Ⅱ patients undergoing orthognathic surgery were randomly divided into two groups： group U received urapidil and propfol （n=20）;group P received propofol only （n=20）. Anesthesia was induced with midazolan 0.05mg/kg, fentanyl 2μg/kg, propofol 2.0mg/kg, esmeron 0.8mg/kg. Anesthesia was maintained with sevoflurane of 2.0% in oxygen and propofol. During the operation, group U controlled hypotension by urapidil and propofol and group P controlled hypotension by propofol only. In both groups, the mean arterial blood pressure was maintained within the target range of 55-65mmHg. The blood pressure, MAP and HR in two groups was significantly recorded before anesthesia and controlled hypotension. Meanwhile the scores of surgical field quality （SSFQ） were assessed according to Fromme surgical field quality list. SPSS11.0 software package was used for comparison of the two groups. RESULTS： During controlled hypotension, MAP in two groups were lower than those before anesthesia （P〈0.01）, and MAP in group U at 5min,10min,20min were significantly lower than group P（P〈0.01 ）. Compared with group P, surgical field quality in group U was significantly better, but HR in two groups was all higher than before. CONCLUSION： Urapidil can be used for controlled hypotension in orthognathic surgery safely, effectively and rapidly with better surgical field quality.