地尔硫卓、尼卡地平预防颅脑术后拔管反应的比较

Effect of Diltiazem and Nicardipine on Postoperative Extubation Response in Patients with Intracranial Surgery

目的观察地尔硫卓、尼卡地平预防颅脑术后气管拔管期心血管反应的疗效及使用期间二者对心功能的影响。方法选取60例ASAⅠ～Ⅱ级,颅脑占位择期行开颅手术患者,随机分为:生理盐水组(C组)、尼卡地平15μg/kg组(N组)、地尔硫卓0.2 mg/kg组(D组)。于拔管前2 min静注研究用药。记录给药前、给药后、拔管时、拔管后1,3,5,10 min的血压(BP)、心率(HR)、心搏指数(SVI)、心指数(CI),计算心率收缩压乘积(RPP=心率×收缩压)。结果与给药前相比,拔管期C组最大平均动脉压(MAPmax)平均升高21.1%、最高心率(HRmax)平均增速32.8%、最大率压积(RPPmax)平均增幅达52.2%(P<0.01)。D、N两组均能有效地抑制气管拔管引起的血压升高(MAPmax:2.9%vs3.6%,P>0.05)。与N组相比,D组还有减慢心率的作用(HRmax:12.7%vs 24.6%,P<0.05)。静注地尔硫卓、尼卡地平后CI增加。结论尼卡地平可减轻气管拔管时的升压反应,但不能防止心动过速的发生;地尔硫卓可全面有效地抑制气管拔管时的心血管副反应。

Objective To compare the efficacy of Nicardipine and Dihiazem on the cardiovascular responses during tracheal extubation and emergence from anesthesia in patients with intracranial surgery, and their negative influence on heart function. Methods Sixty ASA I -II patients with intracranial space-occupying lesion undergoing elective intracranial surgery were randomly divided into 0.9% NS group（ Group C） ,0.2 mg/kg Dihiazem group（ Group D） and 15 μg/kg Nicardipine group（ Group N）. The drugs were used two minutes before tracheal extubation. The blood pressure （BP）, heart rate （HR）, stroke volume index （SVI） and cardiac index（CI） was recorded at designed time points ： pre-adminstation, post-adminstation,immediate at extubation, 1,3, 5 and l0 min after extubation. And the rate-pressure product （RPP） was calculated. Results Compared with pre-adminstation, the maximum increase of MAP,HR and RPP in group C were 21.1% ,32.8% and 52.2% associated with tracheal extubation （P 〈 0.01 ）. The increase of MAP induced by tracheal extubation were depressed both by Nicardipine and Dihiazem（ MAPmax： 2.9% vs 3.6% ,P 〉0.05 ）. The inhibitory effects of Dihiazem on HR responding to the tracheal extubation were greater than those of Nicardipine（ HRmax： 12.7% vs 24.6% ,P 〈 0.01 ）. CI increased after the bolus injection of Dihiazem or Nicardipine. Conclusion Nicardipine is effective in depressing pressure response to tracheal extubation but cannot prevent the tachycardia; Dihiazem can produce a greater attenuation on the circulatory responses to tracheal extubation.