硝酸甘油联合艾司洛尔在颌面部骨折复位术中的降压作用

Effects of Controlled Blood Pressuer by Nitroglycerin Conbined Esmolol on Maxillofacial Fractures Reduction

目的:观察硝酸甘油联合艾司洛尔控制性降压技术应用于颌面部骨折复位内固定术中的可行性。方法:选择96例颌面部骨折行骨折复位内固定术的患者,随机分为对照组(A组)、硝酸甘油降压组(B组)及硝酸甘油复合艾司洛尔降压组(C组),每组各32例。结果:B组诱导后的平均动脉压(MAP)较诱导前明显降低,而心率(HR)则明显增快,HR与收缩压(SBP)的乘积(RPP)增加;C组诱导后的MAP、HR及RPP比诱导前均明显下降,B、C两组诱导后的MAP比较,差异无统计学意义(P>0.05),但与A组比较,差异显著(P<0.01)。A、B两组诱导后的HR及RPP均明显升高,但两组比较,差异无统计学意义(P>0.05),C组诱导后的HR及RPP明显下降,与A、B两组比较,差异显著(P<0.01)。B、C两组术中血量及尿量与A组比较差异显著(P<0.01),C组出血量及硝酸甘油用药量明显低于B组(P<0.01)。3组术后均未见明显心脑栓塞等并发症发生。结论:硝酸甘油复合艾司洛尔控制性降压技术可安全有效地应用于颌面部骨折复位内固定术中。

Objective： To observe the feasibility of deliberated hypotension by nitroglycerin combined with esmolol for treating maxillofacial fractures through rigid internal fixaton. Method： ASA Ⅰ - Ⅱ patients scheduled for maxillofacial fractures through rigid internal fixation were divided randomly and averagely into three groups with 32 cases each：control group （group A）deliberated hypotension by nitroglycerin group （group B）and deliberated hypotension by nitroglycerin combined with esmolol group （group C）. General anesthesia were performed in three groups. Mean arterial pressure （ MAP）, HR, SpO2, ECG and pH were observed and recorded at the dif- ferent time points. RPP （SBP ~ HR） was calculated at the same time points, and itroglycerin dosage bleeding capacity and urine capaci- ty were calculated. Result- MAP, HR and RPP in group C were significantly lower than those before induction during the operation; and MAP and RPP in both group B and group C were significantly lower than those of group A （ P 〈 0. 01 ） ; HR and RPP in group C was significantly slower than that in group A and group B （ P 〈 0, 01 ）. Bleeding capacity and urine capacity in both group B and group C were significantly more different than those in group A. Bleeding capacity and nitroglycerin dosage in the group C were significantly low- er than that in group B （P 〈 0. 01 ） ;Cardiac cerebral embolization and delayed recovery were not found during postoperation, There were not differences for pH among three groups. Conclusion： The deliberated hypotension by nitroglycerin combined with esmolol was a fea- sible technique for treation maxillofacial fractures through rigid internal fixation.