尼卡地平联合小剂量咪达唑仑对眼科老年高血压患者围术期血流动力学及儿茶酚胺的研究

The effect of nicardipine combination with midazolam on hemodynamics and catecholamine in eye elderly perioperative hypertension patients

目的探讨尼卡地平联合小剂量咪达唑仑对眼科合并Ⅱ~Ⅲ级高血压患者围术期血流动力学的影响及血浆儿茶酚胺的变化。方法选择西南医科大学附属医院65岁以上的患者根据美国麻醉师协会(ASA)分为Ⅱ~Ⅲ级,且合并Ⅱ~Ⅲ级围术期高血压眼科手术患者60例。随机分为2组:咪达唑仑+尼卡地平组(A组),咪达唑仑+硝酸甘油(B组),每组30例。患者术前10min静脉缓推咪达唑仑1、5min后血压低于180/110mm Hg行手术治疗。A组:术前5min给予尼卡地平0.5~5.0μg/(kg·min)静脉泵入;B组:术前5min给予硝酸甘油0.1~1.0μg/(kg·min)泵入,根据血压、心率调整泵入速度。观察并记录2组患者给药前(T0)、给药后5min(T1)、注射局麻药时(T2)、手术5(T3)、10(T4)、30min(T5)、术毕(T6)、术后1(T7)、6h(T8)患者的无创袖带收缩压(SBP)、舒张压(DBP)、心率(HR)、心率收缩压乘积(RPP),并于T0及T6时采集静脉血检测血浆肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(D)水平。结果 2组患者基础SBP、DBP、HR、RPP、E、NE、D比较,差异无统计学意义(P>0.05);组间HR、RPP比较,差异有统计学意义(P<0.05);组内SBP、DBP、E、NE、D比较,差异有统计学意义(P<0.05)。结论尼卡地平联合小剂量咪达唑仑能降低眼科手术患者因手术紧张引起的应激反应,降低血压和儿茶酚胺水平,其效果优于硝酸甘油。

Objective To observe the effect of nicardipine and nitro-glycerin on hemodynamics and catecholamine in elderly perioperative hypertension patients underwent ophthalmologic operation.Methods A total of 60 cases of elderly patients with hypertension underwent ophthalmologic operatio with local anesthesia were selected.The ages were≥65 years old,ASA Ⅱ―Ⅲlevel.They were divided into：midazolam＋nicardipine group（group A,n=30）,midazolam＋nitroglycerin group（group B,n=30）.The observe time points were：before delivery（T0）,5 min after the treatment（T1）,injection of local anesthetic（T2）,5 min after surgery（T3）,10 min after surgery（T4）,30 min after surgery（T5）,the end of the operation（T6）,postoperative 1h（T7）and 6 h（T8）,SBP,DBP,HR,RPP were recoeded.Patients′venous blood was collected for measurement of plasma epinephrine（E）,noradr-enaline（NE）and dopamine（D）prior to the delivery and at the end of surgery.Results Two groups of SBP,DBP,HR,RPP,D,E,had no statistically significant difference（P〈0.05）.HR and RPP differences between two groups were statistically significant（P〈0.05）.Within the group of SBP,DBP,E,NE,D difference were statistically significant（P〈0.05）.Conclusion Nicardipine combined with small dose of midazolam could reduce blood pressure and catecholamine levels.The effect was better than that of nitroglycerin.