尼卡地平联合艾司洛尔预防气管导管拔管期心血管反应  

Effects of Nicardipine Combined with Esmolol on Preventing Cardiovascular Response to Tracheal Extubation

作　　者：严伟民[1] 刘和平[1] 姜虹[1] 朱也森[1] 

机构地区：[1]上海第二医科大学第九人民医院麻醉科,上海200011

出　　处：《上海第二医科大学学报》2005年第9期957-959,共3页Acta Universitatis Medicinalis Secondae Shanghai

摘　　要：目的观察尼卡地平和艾司洛尔联合用药对高血压冠心病患者气管导管拔管期间心血管反应的影响。方法选择36名口咽肿瘤术后带气管导管辅助或支持通气入ICU的高血压冠心病患者,随机分为Ⅰ、Ⅱ、Ⅲ三组。拔管前Ⅰ组(对照组)静注生理盐水,Ⅱ组静注艾司洛尔1mg/kg,Ⅲ组静注艾司洛尔1mg/kg和尼卡地平10μg/kg,记录所有患者给药前(基础值),拔管前,拔管时,拔管后5、10min心率(HR)、平均动脉压(MAP)和ECG的ST段变化,并计算HR和收缩压乘积(RPP)。结果Ⅰ组患者出现明显心血管反应,拔管刺激时HR、MAP、RPP显著高于基础值(P<0.01);Ⅱ组和Ⅲ组无明显心血管反应,Ⅲ组拔管前及拔管时HR、MAP、RPP均较基础值低(P<0.01),而Ⅱ组拔管前、拔管时的MAP较基础值无明显差异(P>0.05)。结论尼卡地平复合艾司洛尔,可以有效地控制高血压冠心病患者的气管导管拔管期心血管反应,且无显著副作用。Objective To observe the effect of combined administration of nicardipine and esmolol on cardiovascular response to tracheal extubation of patients with hypertension and coronary heart disease （CHD）. Methods Thirty-six patients with hypertension and CHD undergoing oral pharynx tumor operation with the endotracheal tube remained in ICU were selected. All these patients were randomly divided into three groups： Ⅰ , control group;Ⅱ , esmolol group; and Ⅲ, studied group. Before extubation, the patients were pretreated with saline infusion in group Ⅰ , esmolol 1 mg/kg in group Ⅱ , and esmolol 1 mg/kg and nicardipine 10 μg/kg in group Ⅲ. Heart rate （HR） , mean systemic arterial pressure （MAP） and ST change in ECG were separately recorded premedication, before extubation, at extubation, 5 min and 10 min after extubation. The rate-pressure product （RPP） was also calculated. Results Patients in group Ⅰ had obvious cardiovascular response, especially at extubation. HR, MAP and RPP were much higher than the basic value （P 〈 0. 01 ） , but those in group Ⅱ and group Ⅲ had no obvious cardiovascular response. HR, MAP, RPP were even lower than the basic value in group Ⅲ （P 〈0.01）. There was no difference in MAP of group Ⅱ before and at extubation （P 〉 0. 05）. Conclusion lol can effectively control cardiovascular response to extubation vious side effects. The combined administration of nicardipine and esmoamong the hypertensive and CHD patients without obvious side effects.

关 键 词：尼卡地平 艾司洛尔 高血压 冠心病 气管拔管 心血管反应 

分 类 号：R614[医药卫生—麻醉学]