胸腰椎手术患者硝普钠或尼莫地平控制性降压的安全性

The Safety of Controlled Hypotension Induced with Sodium Nitroprusside versus Nimodopine in Patients Undergoing Elective Chest Lumbar Vertebra Surgery Patient

目的评价胸腰椎手术全麻患者硝普钠或尼莫地平控制性降压的安全性。方法择期行胸腰椎手术全麻患者40例,随机分为Ⅰ组(硝普钠组,n=20)和Ⅱ组(尼莫地平组,n=20)。在静吸复合全身麻醉下,分别于手术开始时静脉输注硝普钠(0.5-0.8ug·kg-1·min-1)或尼莫地平(8-10ug·kg-1·min-1),使平均动脉压降至55-65mmHg,并维持此水平至术毕。用超声血流监测仪监测血液动力学变化,记录降压前即刻(基础值)、降压10min、20min、60min及停降压药后10min、20min时主动脉血流量(ABF)、心输出量(CO)、主动脉每搏流量(SVa)、左室射血时间(LVETi)、左室射血峰速度(PV)、血流加速度(Acc)、主动脉内全身血管阻力(TSVRa);记录术出血量、输液量、尿量、术后伤口引流量及需异体输血情况;于术前和术后24h抽取静脉血,测定肝肾功能。结果与基础值比较,两组降压过程中及停药降压后MAP及TAVRa降低,降压过程中HR增快,Ⅰ组降压过程中CVP降低,ABF、CO增高,LVETi延长(P【0.05)。与Ⅱ组比较,Ⅰ组停药后20min时MAP升高,LVETi延长,降压时间及升压时间缩短,术中出血量和异体输血量降低(P【0.05或0.01)两种药物对肝功能无明显影响。结论硝普钠及尼莫地平均可安全地用于全身麻醉患者控制性降压,但硝普钠降压的可控制性优于尼莫地平,且能更好地减少术中出血。

Objective To investigate the effects of controlled gypotension induced with sodium nitroprusside( SNP) or nimodopine on hemodynamics during Chest lumbar vertebra union surgery operation and postoperative hepatic and renal function. Methods Forty ASAⅠorⅡ patients aged 20 - 70 yrs weighing 50 - 80 kg sched- uled for total hip replacement or open reduction and internal fixation of fracture of acetabulum were randomized to receive eigher SNP( group Ⅰ) or nimodopine( group Ⅱ) for induced hypotension during operation. Each group included 20 patients. Radial artiry and right internal jugular vein were cannulated for BPand CVP monitoring. The probe of Hemo - SinicTM 100 esophageal supersonic hemodynamic monitor was obtained. EGC,thermodynamics including MAP,HR,CO and other parameters,SpO2 and PETCO2 were continuously monitored. Anesthesia was induced with propofol 2 mg·kg - 1,fentanyl 2 - 4 ug·kg - 1 and vecuronium 0. 1mg·kg - 1 and main- tained with 1. 5% isoflurane and continuous infusion of propofol( at 4 - 5 mg·kg·h - 1) and imtermittent i. v. boluses of vecouronium after tracheal intubation. MAP was reduced to 55 - 65 mmHg with SNP( at a rate of 0. 5 - 0. 8 ug·kg - 1·min - 1) or micardipine( at 8 - 10ug·kg - 1·min - 1) . Intraoperative blood transfusion and postoperative drainage from the wound were measured and recorded. Hemodynamic parameters were recorded before hypotension and 10,20,60 min after start of in- duced hypotension and 10 and 20 ions after recovery from hypotension. Hepatic and renal functions were measured before and after operation using total bilirubin,AST, ALT,BUN and creatinine. Rsults The two groups were comparable with respect to sex ratio( M / F) ,age,height,body weight,during of induced hypotension and opera- tion. MAP and systemic vascular resistance( SVR) were significantly reduced and tachycardia developed during hypotension in both groups. The left ventricular ejection time was significantly prolonged and aortic blood flow( ABF) and cardiac output( CO) were significantly increased and CVP was lowered during hypotension as compared to the baseline values in SNP group. BUN was significantly reduced after operation( P < 0. 05) ,but there was little change in certainties in both groups. The amount of postoperative drainage from the wound was not significantly different between the two groups,but the intraoperative blood loss was much less in SNP group. Conclusion Sodium nitroprusside is superior to NIMODOPINE for controlled hypotension in terms of controllability and decrease in intraoperative blood loss.