髋部手术全麻患者硝普钠或尼卡地平控制性降压的安全性  

The safety of controlled hypotension induced with sodium nitroprusside versus nicardipine in patients undergoing elective hip operations

作　　者：章彦[1] 许幸[2] 苑贵敏[1] 陈晓菲[1] 孙晓雄[1] 

机构地区：[1]北京积水潭医院麻醉科,100035 [2]北京大学第一医院麻醉科

出　　处：《中华麻醉学杂志》2006年第3期199-203,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价髋部手术全麻患者硝普钠或尼卡地平控制性降压的安全性。方法择期行髋部手术全麻患者20例,随机分为Ⅰ组(硝普钠组,n=10)和Ⅱ组(尼卡地平组,n=10)。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(0．5-8 μg·kg-1·min-1)或尼卡地平(1-8μg·kg-1· min-1),使平均动脉压降至55-65 mm Hg,并维持此水平至术毕。用食管超声多普勒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15 min、30 min、60 min及停降压药后15 min、30 min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);记录术中出血量、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24 h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降压药后MAP及TSVRa降低,降压过程中HR增快,Ⅰ组降压过程中CVP降低, ABF、CO升高,LVETi延长(P<0．05)。与Ⅱ组比较,Ⅰ组停降压药后30 min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率降低(P<0．05或O．01)。两种药物对肝、肾功能无明显影响。结论硝普钠及尼卡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性优于尼卡地平,且能更有效地减少术中出血。Objective To investigate the effects of controlled hypotension induced with sodium nitrnprusside （SNP） or nicardipine on bemedynamics during hip operation and postoperative hepatic and renal function. Methods Twenty ASA Ⅰ or Ⅱ patients aged 20-70 yrs weighing 50-80 kg scheduled for total hip replacement or open reduction and internal fixation of fracture of acetabulum were randomized to receive either SNP （group Ⅰ ） or nieardipine （group Ⅱ） for induced hypotension during operation. Each group included 10 patients. Radial artery and right internal jugular vein were eannulated for BP and CVP monitoring. The probe of Hemo-Sonie^TM 100 esophageal supersonic hemedynamie monitor （Arrow U.S. A） was placed in the esophagus and fixed when best signal was obtained. ECG, hemedynamies including MAP, HR, CVP, CO and other parameters, SpO2 and PEr CO2 were continuously monitored. Anesthesia was induced with propofol 2 mg·kg^- 1 , fentanyl 2-3 mg·kg^- 1 and veeuronium 0.1 mg·kg^- 1 and maintained with 1.5% isoflurane and continuous infusion of propofol （at 4-6 mg·kg^- 1·h^-1 ） and intermittent i.v. boluses of vecuronium after tracheal intubation. MAP was reduced to 55-65 mmHg with SNP （at a rate of 0.5-8.0 μg·kg^-1·min^-1） or nieardipine （at 1.0-8.0 μg·kg^-1·min^-1 ） . Intraoperative blood loss and blood transfusion and postoperative drainage from the wound were measured and recorded. Hemodynamic parameters were recorded before hypotension and 15, 30 and 60 rain after start of induced hypotension and 15 and 30 rain after recovery from hypotension. Hepatic and renal functions were measured before and after operation using total bilirubin, AST, ALT, BUN and creatinine. Results The two groups were comparable with respect to sex ratio （M/F）, age, height, body weight, duration of induced hypotension and operation. MAP and systemic vascular resistance （SVR） were significantly reduced and taehyeardia developed during hypotension in both groups. The left ventricular ejection time w

关 键 词：硝普钠 尼卡地平 控制性降压 血液动力学现象 髋部手术 全麻 

分 类 号：R614.2[医药卫生—麻醉学]