艾司洛尔联合硝普钠控制性降压对鼻内镜手术患者心功能的影响

Influence of controlled hypotension using Esmolol and Sodium Nitroprusside on cardiac function in patients undergoing endonasal sinus surgery

目的探讨艾司洛尔联合硝普钠控制性降压对行功能性鼻内镜术(FESS)患者的心功能影响。方法将58例ASAⅠ～Ⅱ级择期行FESS术的患者随机分为观察组28例和对照组30例。对照组仅予以硝普钠控制性降压;观察组予以艾司洛尔联合硝普钠控制性降压。2组患者均予以常规麻醉诱导,监测心电图(ECG)、平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2),并应用彩色多普勒超声诊断仪监测心输出量(CO)、每搏输出量(SV)及射血分数(EF)。2组术中MAP控制在基础血压的2/3,记录术前、降压平稳后20min及停止降压20min时HR、MAP、CO、SV和EF,同时记录手术时间、术中出血量及硝普钠用量。结果对照组降压后各时点HR高于术前,SV低于术前;观察组降压平稳20min时点CO低于术前;2组降压平稳20min时点MAP均低于术前,差异均有统计学意义(P<0.05和P<0.01)。观察组降压平稳20min时点HR低于对照组,降压后各时点SV均高于对照组;术中出血量、手术时间及硝普钠用量均低于对照组,差异有统计学意义(P<0.05和P<0.01)。结论艾司洛尔联合硝普钠控制性降压用于FESS术安全有效,可明显减少术中出血,利于手术操作,未见明显的心功能改变。

Objective To explore the effect of controlled hypotension using esmolol and sodium nitroprusside on cardiac function in patients undergoing endonasal sinus surgery.Methods 58 patients with ASA grade Ⅰ~Ⅱ undergoing selective endoscopic sinus surgery were randomly divided into observation group（n=28） and control group（n=30）.The control group was only given nitroprusside for controlled hypotension;the observation group received esmolol combined with sodium nitroprusside for controlled hypotension.The standard intravenous anesthesia induction was performed in all patients.ECG,MAP,HR,SpO2 were monitored before and during operation.Cardiac output（CO）,Stroke volume（SV）,and left ventricular ejection fraction（LVEF） were measured by doppler echocardiography.In both groups,mean arterial blood pressure（MAP） was controlled to 2/3 of basic MAP.HR,MAP stop buck 20min,CO,SV and EF were recorded preoperatively,buck stable after 20min,intraoperative bleeding volume and sodium nitroprusside dosage were observed.Results HR at different time points in control group were higher than before the operation,SV was lower than the preoperative;CO was lower in observation group at 20min antihypertensive smooth than the preoperative;MAP were lower in both groups in antihypertensive stable at 20min than before the operation,the differences were statistically significant（P0.05 and P0.01）.HR in observation on hypotensive stable at 20min was lower than that of control group,SV were higher than that of the control group in each time;amount of intraoperative bleeding,operation time and dosage of sodium nitroprusside were lower than the control group,and the difference was statistically significant（P0.05 and P0.01）.Conclusion Controlled hypotension with sodium nitroprusside combined with esmolol has benefit to operate,decrease the amount of bleeding without changes in cardiac function.It is proved through experimenter that the method is safe and feasible.