乌拉地尔联合酚妥拉明控制体外循环期间高血压的效果

Effect of urapidil combined with phentolamine on hypertension during extracorporeal circulation

目的观察乌拉地尔联合酚妥拉明控制体外循环期间高血压的效果。方法 90例主动脉瓣和二尖瓣置换术患者随机分为酚妥拉明组（A组）、乌拉地尔组（B组）和乌拉地尔联合酚妥拉明组（C组）观察3组患者体外循环期间降压药物使用情况,用药前后平均动脉压（MAP）变化情况以及两次用药间隔时间（t）并记录。观察主动脉开放至心脏复跳的时间（T）以及复跳情况;记录前并行循环时间、主动脉阻断时间和后并行循环时间,心脏复跳后1~5 min（T1）、5~10 min（T2）、10~20 min（T3）、20~30 min（T4）和30~60 min（T5）多巴胺使用情况;观察并记录麻醉诱导前1 min（t1）、体外循环（CPB）前1 min（t2）、CPB 30 min（t3）、CPB 60 min（t4）、CPB结束（t5）、术后2 h（t6）、术后12 h（t7）和术后24 h（t8）各时点血浆TNF-α和IL-6浓度变化情况。结果 3组患者体外循环期间使用降压药物前后组间MAP变化情况比较差异无显著性（P〉0.05）,B组较A组患者使用降压药物间隔时间有所延长,C组患者使用降压药物间隔时间较A、B组明显延长（P〈0.05）。3组患者心脏复跳情况、前并行循环时间、主动脉阻断时间和后并行循环时间比较差异无显著性（P〉0.05）。B组患者在心脏复跳后不同时间段平均每分钟多巴胺使用量均较A、C组高,C组患者在心脏复跳后不同时间段平均每分钟多巴胺使用量均较A组高（P〈0.05）;各组患者心脏复跳后多巴胺的使用量随时间逐渐减少。CPB时各组患者血浆TNF-α和IL-6浓度随时间逐渐升高,CPB结束时其浓度达最高;C组患者血浆TNF-α浓度在CPB结束及术后各时间点均较A、B组低（P〈0.05）,CPB结束、术后2和12 h C组患者血浆IL-6浓度均较A、B组低（P〈0.05）。结论乌拉地尔联合酚妥拉明应用于成人体外循环期间进行降压,可以提供比较平稳的降压效果而不导致血压过低,同时还可以减少或延缓单独用药产生的药物耐受。

Objective To study the effect of urapidil combined with phentolamine in the management of hypertension during extracorporeal circulation. Methods Ninety patients undergoing aortic and mitral valve replacement were randomly divided into 3 equal groups to receive treatment with phentolamine （group A）, urapidil （group B）, or both （group C） during extracorporeal circulation. The mean arterial pressure （MAP） before and after drug administration, time interval of two administrations, spontaneous recovery of heart beat after aorta unclamping, ventricular arrhythmia, changes of ST-segment 1 min after the recovery of heart beat, ante-parallel cycle time, aorta clamping time, post-parallel cycle time, dopamine dose after cardiac resuscitation, and perioperative changes of plasma TNF-a and IL-6 levels were recorded. Results There was no significant difference in MAP between the 3 groups before or after hypotensive drug administration （P〉0.05）. The time interval of two hypotensive drug administrations was longer in group C than in groups A and B （P〈0.05）. The incidence of spontaneous recovery of heart beat after aorta unclamping, inddence of ventricular arrhythmia, changes of ST-segment 1 min after the recovery of heart beat, ante-parallel cycle time, aorta clamping time, and post-parallel cycle time were all comparable between the 3 groups. The dose of dopamine administered after cardiac resuscitation was significantly larger in group B than in groups A or group C （P〈0.05）. The plasma levels of TNF-a and IL-6 were significantly increased after CPB and after the operation in all the groups, but were lowed in group C than in groups A and B at the end of CPB and at 2 h and 12 after the operation. Conclusion Urapidil combined with phentolamine can control hypertension during extracorporeal circulation without causing hypotension.