美托洛尔、尼卡地平对手术期间高血压患者心肌的保护作用(英文)

Protective effects of metoprolol and nicardipine on myocardium during perioperation in hypertension patients

目的高血压患者因其本身的病理生理改变,手术期间心肌缺血损伤的发生率高于正常人,通过观察美托洛尔、尼卡地平干预对高血压患者非心脏手术前后心肌钙蛋白I(CTnI)的影响及心率血压变化,以探讨其对心肌的保护作用。方法选择ASAⅠ～Ⅱ级高血压病史5～20年择期行上腹部或胸部手术患者60例,采用抽签法随机分为对照组(Ⅰ)和美托洛尔(Ⅱ)、尼卡地平(Ⅲ)治疗组。在手术前后采静脉血,测心肌钙蛋白I同时观察围插管期心率血压变化。结果Ⅰ组术后CTnI浓度明显高于术前(F=126.79,P<0.01);而Ⅱ、Ⅲ组CTnI浓度术后轻度升高与手术前比较无统计学差异。心率血压方面插管即刻Ⅱ组、Ⅲ组与术前无明显变化与Ⅰ组比较有显著差异(F=19.26,P<0.01)。插管后5min,血压、心率基本平稳。结论美托洛尔、尼卡地平不但能有效抑制全麻诱导气管插管所致的心血管反应,而且对原发性高血压患者非心脏手术手术期间心肌缺血损伤也具有良好的保护作用。

Aim For patients with hypertension, the pathological and physiological changes in their body may cause a higher incidence of myocardial ischemia compared with normal persons. Through investigating the effects of metoprolol and nicardipine on cardiac troponin I (CTnI) and hemodynamics changes during perioperation in hypertension patients, so as to know its protective effect on cardiac muscle. Methods Sixty hypertension patients who suffered from this disease for 5-10 years and even were evaluated to ASAⅠ?Ⅱscheduled for elective abdominal or thoracic operation were randomly divided into control group￡¨Group￠?￡(c), metoprolol group￡¨Group ￠ò￡(c)and nicardipine group(Group Ⅲ).Results CTnI and hemodynamics changes were assessed at before and after anesthesia. The level of CTnI after anesthesia was higher significantly than before anesthesia in Group Ⅰ(F=126.79, P< 0.01￡(c); CTnI did not change markedly after anesthesia in GroupⅡand Group Ⅲ. Heart rate (HR)and blood pressure (BP) did not change markedly after anesthesia in GroupⅡand Group Ⅲ, but there was significant difference between two groups compared with Group￠?￡¨P< 0.01￡(c).HR and BP did not change significantly at 5 minutes after intubation in three groups.Conclusion Metoprolol and nicardipine can inhibit the cardiovascular reaction during induction and intubation of general anesthesia, and can also protect cardiac muscle during perioperation in primary hypertension patients.