厄贝沙坦氢氯噻嗪片联合硝苯地平片对老年患者全身麻醉血流动力学的影响

Effect of irbesartan hydrochlorothiazide tablets combined with nifedipine tablets on hemodynamics in elderly patients undergoing general anesthesia

目的分析长期口服厄贝沙坦氢氯噻嗪片老年患者行全身麻醉的血流动力学变化。方法选择2018年12月-2019年12月上海交通大学医学院附属第九人民医院ASAⅡ级老年择期手术患者68例,年龄65~75岁。按平时口服降压药分成A组(硝苯地平片组)和B组(硝苯地平片联合厄贝沙坦氢氯噻嗪片组),每组34例。手术日早晨停用厄贝沙坦氢氯噻嗪片和硝苯地平片。入室后开放静脉通路,常规监测心电图ECG、血压BP、氧饱和度SpO2、心率HR。2组均予静脉滴注乳酸钠林格氏液(5~7) mL/Kg补充容量,预供氧去氮3 min,使氧饱和度SpO2达98%以上,静脉缓慢给芬太尼1.5μg/kg,咪唑安定0.06mg/kg,丙泊酚1.5mg/kg,观察患者眼睑反应及意识消失后,再给顺式阿曲库铵0.15mg/kg,面罩加压通气,2 min后,完成气管插管。术中用七氟烷和丙泊酚维持麻醉。在麻醉诱导前、插管后即刻,切皮前,手术进行30 min,手术结束时5个时间点,记录2组平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)。结果 2组患者麻醉诱导前MAP、HR、CVP差异基本无统计学意义。2组患者插管即刻MAP、HR、CVP均有上升;但B组在切皮前,手术进行30 min,MAP、HR、CVP均有下降,B组经液体扩容和小剂量升压药去氧肾上腺素治疗,MAP和CVP恢复,差异有统计学意义(P<0.05)。至手术结束时,2组患者的MAP、HR、CVP基本接近诱导前水平,差异均无统计学意义。所有患者麻醉效果满意。结论长期口服厄贝沙坦氢氯噻嗪片的老年患者,如果需要全身麻醉,麻醉医师需要注意术中血流动力学的变化,防止其出现持续低血压而影响重要脏器的血流灌注。

Objective To analyze the hemodynamic changes under general anesthesia in elderly patients with long-term oral irbesartan hydrochlorothiazide tablets.Methods 68 elderly patients aged 65~75 years who were ASA Ⅱ and received elective surgery in the Shanghai Ninth People’s Hospital Affiliated to Medical College of Shanghai Jiaotong University from December2018 to December 2019 were selected.According to the usual oral antihypertensive drugs,they were divided into group A(nifedipine tablets group) and group B(nifedipine tablets combined with irbesartan hydrochlorothiazide tablets group),with 34 cases in each group.Irbesartan hydrochlorothiazide tablets and nifedipine tablets were discontinued in the morning of operation day.After entering the operating room,the venous access was opened.ECG,BP,SpO2 and HR were routinely monitored.Both groups were given intravenous infusion of sodium lactate Ringer’s solution(5~7) mL/kg to supplement the volume,and were given pre-supply oxygen to remove nitrogen for 3 minutes,so that the oxygen saturation SpO2 reached 98% or more.Fentanyl(1.5 μg/kg),midazolam(0.06 mg/kg) and propofol(1.5 mg/kg) were given intravenously slowly.After patient’s eyelid reaction and consciousness disappeared,cis-atracurium was given 0.15 mg/kg and face mask was used for pressure ventilation.After 2 minutes,endotracheal intubation was completed.Anesthesia was maintained with sevoflurane and propofol during operation.The mean arterial pressure(MAP),heart rate(HR),and central venous pressure(CVP) were recorded at the following time points:before anesthesia induction,immediately after intubation,before skin incision,the operation lasted for 30 minutes,and at the end of operation.Results There was no significant difference in MAP,HR and CVP between the two groups before anesthesia induction.The MAP,HR,and CVP of the two groups increased immediately after intubation.However,before the skin incision and 30 minutes after the operation,the MAP,HR,and CVP of group B decreased.In group B,MAP and CVP were recovered after liquid volume expansion and small dose of norepinephrine,the difference was statistically significant(P<0.05).By the end of the operation,he MAP,HR,and CVP of the two groups were basically close to the pre-induction levels,and the differences were not statistically significant.The anesthetic effect of all patients was satisfactory.Conclusion If general anesthesia is needed in the elderly patients who take irbesartan hydrochlorothiazide tablets for a long time,anesthesiologists should pay attention to the changes of hemodynamics during the operation to prevent continuous hypotension from affecting the blood perfusion of important organs.