尼卡地平和艾司洛尔对血液动力学的影响

The effects of nicardipine and esmolol on hemodynamics in human

目的 对比观察全麻术中单独或联合应用尼卡地平和艾司洛尔对血液动力学的影响 ,为临床合理用药提供参考依据。方法 45例ASAⅠ～Ⅱ级择期颅脑手术患者 ,年龄 1 8～ 60岁 ,用1 1～ 1 3MAC异氟醚吸入麻醉。随机平均分成 3组 ,每组 1 5例。当术中平均动脉压 (MAP)超过麻醉前水平 1 5 %时 ,单次静脉注射尼卡地平 0 0 1mg/kg(N组 ) ;当心率超过 90次 /分时 ,单次静脉注射艾司洛尔 1mg/kg(E组 ) ;MAP和心率均达到标准时 ,单次静注射尼卡地平 0 0 1mg/kg和艾司洛尔1mg/kg(NE组 )。连续监测给药前后每博输出量 (SV)、心输出量 (CO)、血流加速度 (ACC)、左室射血时间 (LVET)、全身血管阻力 (SVR)等血液动力学参数的变化。结果 N组给药后SVR和MAP分别下降 2 3 7%和 1 2 2 % ,HR、ACC、PV和CO分别增加 1 1 5 %、1 3 3 %、1 3 1 %和 1 5 7%。E组给药后HR、ACC、PV和CO分别减少 1 6 3 %、2 3 9%、1 0 7%和 1 7 5 % ,MAP无显著变化。NE组MAP、HR、ACC和PV分别降低 1 5 3 %、1 6 3 %、1 3 5 %和 4 4% ,SV、CO和SVR无显著性变化。结论 尼卡地平适用于不伴有心动过速的血压升高患者 ;艾司洛尔适用于心功能良好的单纯心动过速患者。两药合用可以取长补短 。

Objective To Compare the hemodynamic changes after intravenous injection of nicardipine or esmolol alone or in combination of the two drugs during general anesthesia.Methods Forty five neurosurgical patients,ASA classⅠ Ⅱ,were allocated into three groups ( n= 15 in each group).Anesthesia was maintained with 1 1 1 3 MAC isoflurane. When the mean arterial pressure (MAP) increased over 15% of the baseline,nicardipine 0 01mg/kg was injected intravenously (Group N).Esmolol 1mg/kg was injected iv ,when heart rate (HR) was over 90 bpm(Group E).When both MAP and HR reached to the same guidelines,nicardipine 0 01mg/kg and esmolol 1mg/kg were injected (Group NE).The hemodynamic parameters were measured.Results In group N,SVR and MAP decreased by 23 7% and 12 2% after nicardipine,while HR,ACC,PV and CO increased 11 5%,13 3%,13 1% and 15 7%,respectively.HR,ACC,PV and CO decreased by 16 3%,23 9%,10 7% and 17 5%,respectively,and MAP was not changed significantly after esmolol was given.In group NE,MAP,HR,ACC and PV decreased by 15 3%,16 3%,13 5% and 4 4%,respectively,and SV,CO and SVR were not changed significantly after nicardipine and esmolol were administered intravenously.Conclusion Nicardipine alone is suitable for the hypertension without an increase in HR.Esmolol can be used for the patients with tachycardia and better cardiac function.The combination of nicardipine and esmolol is suitable for the patients with hypertension with tachycardia.