乌拉地尔复合艾司洛尔控制性降压在高血压患者脊柱手术中的应用  

作　　者：唐金良[1] 林高翔[1] 

机构地区：[1]桂林医学院附属医院麻醉科,541001

出　　处：《当代医学》2013年第2期148-150,共3页Contemporary Medicine

摘　　要：目的评估在经后路椎体间植骨、椎弓根钉内固定术中,高血压患者脊柱手术中乌拉地尔复合艾司洛尔控制性降压的可行性。方法 60例经后路椎体间植骨、椎弓根钉内固定术高血压患者随机分为两组,即U组(单纯乌拉地尔组)、U-E组(乌拉地尔复合艾司洛尔组),各3O例。手术开始时即行控制性降压,U组:先静脉注射盐酸乌拉地尔0.4mg/kg,此后持续泵注乌拉地尔,维持初始量20～25μg/(kg·min);U-E组:先静脉注射盐酸乌拉地尔0.4mg/kg、艾司洛尔10mg,此后持续泵注盐酸乌拉地尔20～25μg/(kg·min),同时持续泵注艾司洛尔,速率20～30μg/(kg·min)。使平均动脉压(MAP)降至目标血压(MAP降至基础血压的70%)。此后根据血压情况调整用药速度,至手术主要步骤操作完毕、术野止血完毕后停止降压。记录开始降压前即刻(T0)、降压5min(T1)、降压10min(T2)、降压30min(T3)、降压60min(T4)、停止降压后15min(T5)6个时间点血压(SBP、DBP、MAP)、心率(HR)、中心静脉压(CVP)的变化及晶胶体输入量、尿量、出血量和输血量、手术时间,并进行血气分析。结果两组患者MAP的下降均显著低于降压前(P<0.01);降压期间,U组心率在T1、T2、T3时增快,与T0比较有差异有统计学意义;U-E组的心率显著低于U组(P<0.05)。两组术中出血量、尿量、输血量比价,差异无统计学意义(P>0.05)。结论乌拉地尔复合艾司洛尔控制性降压应用于高血压患者脊柱手术安全、有效,可控性良好。Objective To evaluating the effect of esmolol combined with Urapidil during induced hypotension on hypertension patients in spinal surgery.Methods 60 patients were randomLy divided into two groups：group U（n=30）was simple Urapidil;group U-E（n=30）was esmolol combined with Urapidil.Group U initially received Urapidil iv at 0.4mg/kg and group U-E initially received Urapidil 0.4mg/kg and esmololl 10mgiv.The Urapidil dosage was adjusted to maintain the MAP level at target in two groups.Hemodynamic parameters were recorded before and during controlled hypotension：just at the moment of before controlled hypotension（T0 ）、5 min after controlled hypotension（T1 ）、10 min after controlled hypotension（T2 ）、30 min after controlled hypotension（T3 ）、60 min after controlled hypotension（T4 ）、15 min after controlled hypotension finish（T5 ）. Also the operating time、intra-operative blood loss、blood transfusion amounts total liquid transfusion amounts and urine,CVP were recorded.Results The MAP level of two groups were all significantly decreased during controlled hypotension（P0.01）.HR change of group U in Tl , T2 , T3 was faster than T0 and group U-E（P0.05）.But HR change of group U-Ein Tl ,T2 ,T3 ,T4 was lower than T0 .There were no deficiency in the intra-operative blood toss、blood transfusion and urine between both groups（P0.05）.Conclusion Urapidil combined with esmololc.An decrease the intra-operative ldood loss and blood transfusion.prevem the reflex enhancement of HR and reduce the duration of operation.So it is safe and effect for controlled hypotension on hypertension patients in spinal surgery.

关 键 词：乌拉地尔 艾司洛尔 高血压 控制性降压 脊柱手术 

分 类 号：R614[医药卫生—麻醉学]