乌拉地尔和小剂量艾司洛尔联合应用对术后气管拔管心血管反应的影响

Effect of urapidil combined with a small-dose esmolol on the cardiovascular responses associated with tracheal extubation following surgery

目的 观察小剂量乌拉地尔和艾司洛尔联合应用对颅脑手术后气管拔管的心血管反应的影响 .方法 37例行开颅手术患者随机分为 4组 :A组 (n=10 ,乌拉地尔 0 .4 mg·kg- 1 ) ;B组 (n=8,艾司洛尔 0 .5 mg· kg- 1 ) ;C组 (n=9,乌拉地尔 0 .2 mg· kg- 1 +艾司洛尔 0 .2 5 mg· kg- 1 ) ;D组 (n=10 ,生理盐水 2 m L ) .分别于拔管前 2 m in静注 .记录术前、给药前、给药后、拔管即刻、拔管后 1,3和 5 min,回 NICU后的 SBP,DBP,MAP及 HR.结果 D组 :血压、心率在拔管即刻均较术前升高 (P<0 .0 5 ) .A组 :拔管后 1,3和 5 min的血压均低于术前 (P<0 .0 5 ) ,心率在拔管即刻及拔管后明显较术前增快 (P<0 .0 5 ) .C组 :拔管后 SBP明显低于给药前 ,DBP,MAP及 HR无明显变化 .拔管即刻 :A组 HR明显高于B组和 C组 (P<0 .0 5 ) ,A组和 D组的 HR无差异 (P>0 .0 5 ) ,B组拔管即刻 DBP和 MAP高于 A组 (P<0 .0 5 ) ,C组拔管即刻 SBP低于 B组和 A组 (P<0 .0 5 ) .在 NICU:B组心率高于 A组 (P<0 .0 5 ) .结论 小剂量乌拉地尔与艾司洛尔联合应用可预防围拔管期血压升高 ,并能弥补拔管时单独应用乌拉地尔不能有效控制心率的不足 。

AIM To observe the effect of urapidil combined with a small dose esmolol on cardiovascular responses to tracheal extubation following intracranial surgery. METHODS 37 patients undergoing intracranial surgery were included in a randomized study consisting of 4 groups: Group D receiving normal saline as the control, while Groups A, B Group C receiving urapidil 0.4 mg·kg -1 , esmolol 0.5 mg·kg -1 and urapidil 0.2 mg·kg -1 + esmolol 0.25 mg·kg -1 , respectively. Extubation was performed 2 min after the designated drug was intravenously administered. SBP, DBP, MAP and HR were observed at pre operation, pre administration, after administration, at extubation and 1, 3, 5 min after extubation and in NICU. RESULTS BP and HR at extubation were significantly higher than pre operation values in Group D ( P <0.05). BPs 1, 3, 5 min after extubation was significantly lower than those of pre operation and HR was significantly faster than that of pre operation in Group A ( P < 0.05). SBP after extubation was significantly lower than that of pre administration and DBP, MAP, HR showed no change in Group C. SBP at extubation in Group C was significantly lower than those of Group B ( P <0.05) and Group A ( P <0.05) respectively. CONCLUSION Urapidil combined with a small dose esmolol attenuates the cardiovascular responses to tracheal extubation following intracranial surgery.