尼卡地平、美托洛尔对冠心病患者非心脏手术时心率变异性的影响

Changes in heart rate variability following intravenous nicardipine and metoprolol to patients with coronary artery diseases during general anesthesia

目的 比较观察全麻患者插管前静脉给予尼卡地平或美托洛尔后心率变异性 (HRV)的变化。方法 90例冠心病患者随机分为三组 ,每组 30例 ,Ⅰ组为对照组 ,Ⅱ组为尼卡地平组 ,Ⅲ组为美托洛尔组。在诱导前 2min ,Ⅰ组静注生理盐水 10mL ,Ⅱ组静注尼卡地平 2 0 μg·kg-1,Ⅲ组静注美托洛尔 4 0 μg·kg-1,其余操作均相同。结果 与Ⅰ组患者的心率相比 ,Ⅱ组显著升高 (P <0 .0 5 ) ;Ⅲ组显著降低 (P <0 .0 5 )。Ⅱ组和Ⅲ组患者的平均血压在插管前后均显著低于Ⅰ组 (P <0 .0 5 ) ,而这两组间无差别。与Ⅰ组患者相比 ,LF及LF/HF在Ⅱ组升高 (P <0 .0 5 ) ,Ⅲ组降低 (P <0 .0 5 ) ;HF在Ⅱ组无明显变化 ,在Ⅲ组显著升高 (P <0 .0 5 )。结论 插管前静注尼卡地平不能有效抑制插管时交感应激反应 ,反而增强了这种作用 。

Objective To observe the changes in heart rate variability(HRV)following intravenousnicardipine and metoprolol to patients with coronary artery diseases during general anesthesia.Methods Ninetypatients were randomly divided into three groups(n=30).Group I:intravenous administration of saline 10 mL2 rain before induction;groupⅡ:nicardipine 20 pg‘kg一。and group III:metoprolol 40 Fg·kg一。.In each group,BP,HR,LF,HF and LF/HF parameters were recorded.Results Compared with that in group I,HR ingroup II increased significantly(P<0.05)and decreased in group IlI significantly(P<0.05);BP decreasedmarkedly(P<0.05)in groupⅡand group 111.LF and LF/HF increased markedly in groupⅡ(P<0.05)andadversely in groupⅢas compared with group I;HF increased in group II(P<0.05)and remained unchangedin groupⅡ.Conclusion Intravenous administration of metoprolol before intracheal intubation can attenuatethe cardiovascular response induced in BP and HR.Metoprolol can relatively decrease the sympathetic neuralactivity but nicardipine acts adversely.