不同剂量丙泊酚复合乌拉地尔对高血压患者围术期血液流变学的影响

Influence of different dose of Propofol combined with Urapidil on the perioperative haemorheology of the patients with hypertension

目的研究高血压患者麻醉时不同剂量丙泊酚复合乌拉地尔对其血液流变学的影响。方法 90例在丙泊酚全凭静脉麻醉下择期行胃癌根治术的高血压患者,年龄40～70岁,ASAⅠ-Ⅲ级,随机分为3组,每组30例。A组麻醉维持时持续泵注丙泊酚4 mg/(kg.h),B组5 mg/(kg.h),C组6 mg/(kg.h)。围术期必要降压时恒速泵入乌拉地尔3μg/(kg.min)。选取诱导前(T0)、切皮时(T1)、切皮后1 h(T2)、2 h(T3)、3 h(T4)5个时点,记录麻醉过程中使用乌拉地尔的情况;记录各时刻点血液流变学指标:全血黏度(高切、中切、低切)、血浆黏度、红细胞压积、红细胞聚集指数、红细胞刚性指数、纤维蛋白原。结果 B、C组使用乌拉地尔的量明显少于A组(P<0.05),且两组比较无统计学意义(P>0.05)。A组患者血浆黏度、纤维蛋白原在T2、T3、T4均比T0显著升高(P<0.05),其他指标各时点比较无统计学意义(P>0.05);B组患者全血高、中、低切黏度、血浆黏度以及红细胞聚集指数、红细胞刚性指数、纤维蛋白原在T2、T3、T4均比T0显著降低(P<0.05);C组患者全高切黏度、血浆黏度、纤维蛋白原T3、T4比T0显著降低(P<0.05),全血中切黏度T4比T0显著降低(P<0.05),全血低切黏度、红细胞刚性指数和红细胞聚集指数各时间点差异无统计学意义(P>0.05);3组患者红细胞压积各时点比较差异无统计学意义(P>0.05);与A、C组比较,B组全血高、中、低切黏度、红细胞聚集指数、细胞刚性指数、纤维蛋白原在T2、T3、T4显著下降(P<0.05);C组患者全血高、中切黏度、血浆黏度、纤维蛋白原在T3、T4比A组显著降低(P<0.05),其他指标各时点差异无统计学意义(P>0.05)。结论全凭静脉麻醉期间,丙泊酚5 mg/(kg.h)持续泵入且间断复合乌拉地尔能有效降低高血压患者围术期的血液黏度。

【Obejective】 During the hypertensive patients under anesthesia,study the influence of Propofol combined with Urapidil with different dosages on the haemorheology.【Methods】 This study includes 90 patients with gastic cancer and hypertension.At the choosen time,they are treated with gastric cancer radical resection under total intravenous anesthesia.They are 40 to 70 years old and with ASA grade Ⅰ-Ⅲ.They are randomly divided into 3 groups and with 30 patients in every group.During the anesthesia maintaining stage,in group A,we continuely administrate the Propofol for 4 mg /（kg.h）,and 5 mg /（kg.h） in group B,6 mg /（kg.h） in group C.During the perioperation time,when it is necessary to lower the blood pressure,we inject the Urapidil at constant rate（3 μg/kg.min）.The use of Urapidil was recorded during the anesthesia;and also the indexes of haemorheology（Whole blood viscosity high sheer,middle sheer,low sheer）,plasma viscosity,hematocrit,index of erythrocyte aggregation,erythrocyte rigidity index,fibrinogen） were recorded at preinduction（T 0）,incision（T 1）,one hour after incision（T 2）,2 hours after incision（T 3） and 3 hours after incision（T 4）.【Results】 The dosage of Urapidil used in group B and C were significantly lower than in group A（P〈0.05）,and there is no statistic difference between group B and group C（P〈0.05）.In group A,the plasma viscosity and fibrinogen at T 2,T 3 and T 4 were significantly increased compared with T 0（P〈0.05）,while,there was no statistic significance for other indexes at any time point（P〈0.05）.In group B,the whole blood viscosity（high,middle,low sheer）,plasma viscosity and index of erythrocyte aggregation,erythrocyte rigidity index and fibrinogen at T 2,T 3 and T 4 were significantly decreased compared with at T 0（P〈0.05）.In group C,the blood high sheer viscosity,plasma viscosity,fibrinogen at T 3 and T 4 were significantly lower than at T 0（P〈0.05）;the blood middle sheer viscosity at T 4 was significantly decreased than at T 0（P〈0.05）;and there was no significant difference for blood low sheer viscosity,erythrocyte rigidity index and index of erythrocyte aggregation at any time points（P〈0.05）.There was no significant difference for hematocrit at any time point between the three groups（P〈0.05）.Compared with group A and C,the whole blood viscosity（high,middle,low sheer）,index of erythrocyte aggregation,erythrocyte rigidity index,fibrinogen at T 2,T 3,and T 4 were significantly lower in group B（P〈0.05）.The blood viscosity（high,middle sheer）,plasma viscosity,fibrinogen at T 3 and T 4 were significantly lower than in group A（P〈0.05）.And there was no significant difference for other indexes at any time points（P〈0.05）.【Conclusion】 During the total intravenous anesthesia,constantly administrate Propofol at 5 mg /（kg.h） and intermittently inject Urapidil could effectively lower the perioperative blood viscosity of the hypertensive patients.