前列腺素E_1控制性降压对老年患者血浆内皮素和降钙素基因相关肽的影响

Effects of prostaglandin E1 deliberate hypotension on endothelin and calcitonin gene-related peptide in elderly patients

目的研究前列腺素E1用于老年患者控制性降压时对血浆内皮素(ET)和降钙素基因相关肽(CGRP)的影响。方法 86例择期全麻下行鼻内镜手术的老年患者随机分为前列腺素组E(1P组,43例)和硝酸甘油组(N组,43例)。两组分别以前列腺素E1和硝酸甘油持续输注,使平均动脉压(MAP)下降25%～30%。以麻醉前(T0)、降至目标血压时(T1)、降压后30 min(T2)、停降压时(T3)及停降压后30 min(T4)为时点,记录两组MAP、HR和血乳酸(LAC)及ET、CGRP和ET/CGRP值。结果在T1、T2和T3时间点N组HR较降压前增快,P组与降压前接近,N组高于P组(P<0.05)。N组在T2、T3和T4时间点ET值较T0时升高(P<0.05),P组降压前后结果相似,且N组高于P组(P<0.05);P组CGRP自降压后开始升高,T1～T4与T0比较差异有统计学意义,N组CGRP在降压完成时升高但随即开始下降,T2～T4低于P组(P<0.05);P组ET/CGRP在降压前后变化不明显,而N组T2～T4高于T0且高于P组(P<0.05)。结论前列腺素E1用于控制性降压能维持ET/CGRP的稳定,有利于维持老年患者在降压和复压期间血管的正常调节功能。

[Objective] To observe the changes of plasma endothelin （ET） and calcitonin gene-related peptide （CGRP） in elderly patients subjected to deliberate hypotension with prostaglandin El. [Methods] 86 elderly patients scheduled for nasal endoscopic surgery in general anesthesia were randomly divided into groups of prostaglandin E1 （group P） and nitroglycerin （group N）. Hypotension was induced with pmstaglandin E1 and nitroglycerin through continuous infusion respectively, and the mean arterial blood pressure （MAP） was reduced to about 25%-30% reduction of baseline MAP. The MAP and heart rate （HR） were continuously monitored, and the venus blood samples were taken for the measurements of plasma LAC, ET, CGRP and the rates of ET/CGRP before controlled hypotension （To）, at drop to target blood pressure （T1）, at 30 min when hypotension has been maintained （T2）, at the end of hypotension （T3） and 30 min after the halt of hypotension （T4）. [Results] The HR of patients in group N after controlled hypotension significant increased, but that of in group P is no significantly difference. The HR in group P was significantly slower than group N （P 〈0.05）. Compared with T0, the patients in groups N after controlled hypotensiion significant increased in ET, but that in group P has not only changed and significantly lower than group N （P 〈0.05）. The CGRP of group Prised significantly at T2, T3, T4, nevertheless, that in group N was not significantly changed throughout observation.The ET/CGRP in group P have no increase; while in group N are raised significantly at T3, T3, T4. [ Conclusion] Prostaglandin E1 for controlling hypotension are more likely to maintain ET/CGRP balance that is helpful for elderly patients to maintaining the normal regulation of vascular function during induced hypotension.