尼卡地平复合艾司洛尔控制性降压用于婴幼儿腭裂修复术

Combination of Nicardipine and Esmolol for Controlled Hypotension during Palatorrhaphy in Young Children

目的:评价尼卡地平复合艾司洛尔控制性降压用于婴幼儿腭裂修复术的效果。方法:选择择期行腭裂修复术患儿60例,随机分为3组。麻醉后于术者在切口处注射含肾溶液时C组泵注生理盐水,N组泵注尼卡地平,NE组同时泵注尼卡地平及艾司洛尔。观察并记录各组患儿诱导前、降压前即刻、降压后5、10、30min、停药后1、3、5、10min的血压(MAP)、心率(HR)、心率收缩压乘积(RPP),观察各组患儿苏醒情况及气管拔管时间,分别于术前、术中、术毕抽取足背动脉血检测血红蛋白含量(Hb)、红细胞压积(Hct)、血糖(Glu)、乳酸(Lac)含量。结果:降压两组患儿降压后各时点及停止降压后1、3min与诱导前、降压前即刻以及与C组相比,MAP均显著降低(P<0.05),NE组患儿降压后5、10、30min及停止降压后1、3min的HR及RPP均显著低于N组(P<0.05)。NE组及N组术中出血均显著少于C组(P<0.05),但NE组及N组间差异无显著性。3组患儿气管拔管时间差异无显著性,各时点全血Glu及Lac差异亦无显著性。结论:本研究剂量的尼卡地平复合艾司洛尔控制性降压用于婴幼儿腭裂修复术降压过程平稳,安全可靠,效果满意。

Objective：To evaluate the effects of controlled hypotension with Nicardipine and Esmolol on young children undergoing palatorrhaphy.Methods：Sixty young children undergoing slective palatorrhaphy were randomly and evenly divided into three groups：group C,group NE and group N.After the solution including adrenalin was injected in the incision by surgeon,saline were continuously infused in group C,Nicardipine and Esmolol were continuously infused in group NE,and Nicardipine were continuously infused in group N.The heart rate（HR）,mean arterial pressure（MAP）and rate-pressure product（RPP）were recorded at the following time points：before induction,immediately before commencing controlled hypotension,5,10,30minutes after controlled hypotension,and 1,3,5,10minutes after the end of controlled hypotension.Recovery and extubation time were also recorded.Concentration of haematoglobin（Hb）,hematocrit（Hct）,glucose（Glu）and lactic acid（Lac）of blood drawed from dorsal pedal artery were detected before,during and after operation.Results：Group NE and group N had significantly lower MAP at 5,10,30minutes after controlled hypotension,and at 1,3minutes after the end of controlled hypotension than group C（P0.05）.MAP were also significantly lower at 5,10,30minutes after controlled hypotension,and at 1,3minutes after the end of controlled hypotension than that before induction and immediately before commencing controlled hypotension in group NE and group N（P0.05）.Group NE had significantly lower HR and RPP at 5,10,30minutes after controlled hypotension,and at 1,3minutes after the end of controlled hypotension than group N（P0.05）.Group NE and group N had significantly fewer blood loss than group C（P0.05）,but there was no significantly difference between group NE and group N in blood loss.There were also no significantly differences in extubation time.Concentration of Glu and Lac of blood between three groups.Conclusion：Combination of Nicardipine and Esmolol for controlled hypotension are steady,safe and effective during palatorrhaphy in young children.