尼卡地平复合艾司洛尔对H-UPPP患者围拔管期应激反应的影响

Effect of nicardipine combined with esmolol on stress reaction during extubation for H-UPPP

目的评价尼卡地平复合艾司洛尔持续静脉泵注对改良悬雍垂腭咽成形术（H-UPPP）患者围拔管期应激反应的影响。方法选择阻塞性睡眠呼吸暂停低通气综合征（OSAHS）在气管插管全麻下行H-UPPP的患者78例,采用随机数字表法,将患者随机分为2组（n=39）：尼卡地平复合艾司洛尔持续静脉泵注组（A组）及对照组（B组）。观察并记录麻醉诱导前5 min（T1）、停止输注麻醉药时（T2）、拔管时（T3）、拔管后5 min（T4）患者之平均动脉压（MAP）、心率（HR）、血氧饱和度（Sp O2）的变化。计算HR与SBP的乘积（RPP）、麻醉拔管时间、PACU停留时间、术中芬太尼、丙泊酚和顺式阿曲库铵的用量。并于各时点采集非输液侧前臂静脉血样3 m L,检测血浆皮质醇和血糖浓度。结果 A组于T2~T4时MAP及RPP值均低于T1时及B组（P〈0.05）;而B组于T3、T4时MAP值高于T1时,T2~T4时HR及RPP值高于T1时及A组（P〈0.05）;T2~T4时血糖及皮质醇值A、B两组均高于T1时（P〈0.05）,且A组显著低于B组（P〈0.05）;麻醉拔管时间、PACU停留时间A组均明显短于B组（P〈0.05）;芬太尼用量A组显著低于B组（P〈0.05）。结论尼卡地平复合艾司洛尔持续静脉泵注可有效减轻改良雍垂腭咽成形术的患者围拔管期应激反应。

[ Objective ] To study the effect of continuous intravenous infusion of nicardipine combined with es- molol on stress response during extubation period for the patients with Han-uvulopharyngoplasty （H-UPPP）. [Methotis ] Seventy-eight obstructive sleep apnea hypopnea syndrome （OSAHS） patients selected for H-UPPP with the general anesthesia were divided randomly and averagely into continuous intravenous infusion of nicardipine com- bined with esmolol （group A） and control group （ group B）. MAP, HR, SpO_2, plasma cortisone and plasma glucose in venous blood 3 mL at non infusion side forearm was extracted for detection, observed and recorded at 5 min before induction of anesthesia （Tl）, the discontinuation of the infusion of anesthetics （T2）, extubation （T3）, 5 min after extuba- tion（T4） in patients. RPP, extubation time, time in PACU and the dosage of fentanyl, propofol and cisatracurium were calculated. [ Results ] In group A MAP and RPP were lower at T2 to T4 than at T1 and in group B （P 〈0.05）; and in group B MAP was higher at T3 to T4 than at T1, HR and RPP were higher at T2 to T4 than at T1 and in group A （P 〈 0.05）. Plasma cortisone and plasma glucose at T2 to T4 in two groups were higher than those at TI（P 〈0.05）, and were significantly lower in group A than those in group B （P 〈0.05）. Anesthesia extubation time and time in PACU were significantly shorter in group A than in group B （P 〈0.05）. The dosage of fentanyl was significantly lower in group A than in group B （P 〈0.05）. [Conclusion] Continuous intravenous infusion of nicardipine combined with esmolol can reduce effectively stress response during extubation for the patients with Han-uvulopharyngoplasty.