乌拉地尔联合右美托咪啶在CABG术后拔管对心血管反应的观察

Observation of Cardiovascular Response to Extubation of Urapidil Combined with Dextrometridine after CABG

目的:全麻患者气管拔管期因吸痰、呛咳、疼痛和导管刺激等因素可出现血压升高、心率(HR)增快及躁动等不良反应;对于术前存在高血压的CABG患者,可增加心肌氧耗,严重时可导致心脑血管意外,影响患者预后。观察高血压患者全麻CABG术后拔管期应用乌拉地尔联合右美托嘧啶预防心血管反应效果。方法:按照WHO/ISH(世界卫生组织和国际高血压联盟)1999年高血压诊断分级标准,选取60例需行CABG术的高血压3级的患者,术后均使用硝酸甘油注射液(0.5-2.0ug/kg.min)微量泵入扩张冠状动脉;分为乌拉地尔组(A1)、右美托嘧啶组(A2)、乌拉地尔复合右美托嘧啶组(A3)、硝酸甘油(0.5-2.0ug/kg.min)(A4),每组15例。在患者达到气管拔管指征且有创收缩压>140mmHg时,A1组静脉注射乌拉地尔,以12.5 mg乌拉地尔注射剂加人10 ml生理盐水中缓慢静脉注射后,以8-16 mg/h的速度由微量输液泵持续输注;A2组予静脉负荷量右美托咪啶lug/kg,用微量输液泵控制10 min输完,维持设定为0.5 ug/kg.min;A3组采用A1组联合A2组的治疗方案;A4组微量输液泵泵入硝酸甘油(0.5-2.0ug/kg.min));分别记录拔管前30分钟(T1)、拔管时(T2)、拔管后5 min(T3)、10 min(T4)、30 min(T5)时的收缩压(SBP)、心率(HR)、中心静脉血氧饱和度(SCVO2)。结果:与A4组对比,其余3组拔管后SBP、HR、RR、明显降低(P<0.05),SCVO2明显升高(P<0.05);与A3组对比,A1组患者拔管前后的HR、RR增快、SCVO2明显下降(P<0.05);与A3组对比,A2组患者患者拔管前后的SBP明显升高(P<0.05)。结论:乌拉地尔联合右美托嘧定,能有效地控制高血压患者全麻CABG术后拔管期气管刺激所引起的呼吸和血流动力学过度波动的应激反应。

Objective:Anesthesia patient extubation period due to suction,cough,pain,and there may be other factors stimulating catheter blood pressure,heart rate(HR)faster and restlessness and other adverse reactions;For preoperative hypertension CABG patients,increased myocardial oxygen consumption,severe cases can lead to cardiovascular and cerebrovascular accident affecting prognosis.Anesthesia in patients with hypertension was observed after CABG extubation composite application URAPIDIL dexmedetomidine effect against cardiovascular reactions.Method:According to WHO/ISH(World Health Organization and the International Society of Hypertension League)1999 classification of hypertension diagnostic criteria Sixty patients required CABG surgery in patients with hypertension 3 is divided into urapidil group(A1),dextromethorphan trust pyrimidine group(A2),uRAPIDIL composite dexmedetomidine group(A3),Nitroglycerin Injection(A4),15 cases each.Tracheal extubation in patients achieved and invasive systolic>140mmHg time,A1 intravenous urapidil group to 12.5 mg urapidil injection was added 10 ml saline slow intravenous injection at 8 a 16 mg/h speed micro-infusion pump by a continuous infusion;A2 group the right to intravenous loading dose dexmedetomidine lug/kg,with a microinfusion pump control 10 min losers,maintain set 0.5 ug/kg.min;A3 combined group with group A1 A2 group treatment programs;A4 micro infusion pump into the group Nitroglycerin Injection(0.5-2.0ug/kg.min));were recorded 30 minutes before extubation(T1),extubation(T2),after extubation 5 min(T3),10 min(T4),30 min(T5)when the systolic blood pressure(SBP),heart rate(HR),central venous oxygen saturation(SCVO2)Full set of data as mean±standard deviation(),said with SPSS 13.0 software using t test was used for statistical analysis.Results:Group compared with the A4,and the remaining three groups before and after extubation SBP,HR,RR,significantly lower(P<0.05),SCVO2 significantly increased(P<0.05);compared with group A3,A1 group of patients before and after extubation HR,RR faster,SCVO2 decreased significantly(P<0.05);compared with group A3,A2 group of patients before and after extubation SBP decreased significantly(P<0.05)。Conclusion:URAPIDIL ethyl compound dextromethorphan care setting,can effectively control hypertension in patients after CABG anesthesia endotracheal extubation respiratory stimulation caused by excessive volatility and hemodynamic stress response.