全麻下乌拉地尔联合硝酸甘油控制性降压对鼻内镜手术患者心率与心电图ST-T的影响  

TO EXPLORE THE EFFECT URAPIDIL COMBINED WITH NITROGLYCERIN ON HEART RATE AND ECG ST-T SEGMENT DURING THE COURSE OF NASAL ENDOSCOPY FOR THE PURPOSE OF CONTROL HYPERTENSION UNDER GENERAL ANESTHESIA

作　　者：黎哲敏[1] 付小春[1] 包陈娟[1] 宁素梅[1] 肖祥礼[1] 尹红娟[1] 赵艳[1] 毛斯坦 

机构地区：[1]广西医科大学第九附属医院麻醉科,北海536000

出　　处：《广西医科大学学报》2015年第1期56-59,共4页Journal of Guangxi Medical University

基　　金：北海市科学技术局科研项目(No.20120600)

摘　　要：目的：探讨乌拉地尔联合硝酸甘油控制性降压对功能性鼻内镜术（Functional endoscopic sinus operation,FESS）患者心率（HR）与心电图（ECG）ST-T的影响。方法：择期行鼻内镜手术患者60例（ASA分级Ⅰ-Ⅱ级）,随机分为A、B两组,每组30例。A组采用单纯硝酸甘油行控制性降压；B组采用乌拉地尔联合硝酸甘油行控制性降压。两组患者均采用常规麻醉诱导气管内插管全身麻醉,术中平均动脉压（MAP）控制在基础血压的70%-75%,分别观察两组患者麻醉前（T0）,全麻期间控制性降压前（T1）、降压平稳20 min（T2）、停止降压20 min后（T3）及手术结束时（T4）的 ECG、HR、MAP、脉博氧饱合度（SpO2）、呼气末二氧化碳分压（PET CO2）,并用床边手持十二导联心电图机采集 ECG分析 ST-T变化,同时记录手术时间、术中出血量及硝酸甘油用量。结果：A组降压后各时点 HR高于术前,降压平稳20 min后9例 ECG ST-T有改变,停止降压20 min后此9例 ECG ST-T恢复正常；B 组降压平稳后20 min ECG ST-T 段无改变,两组比较差异均有统计学意义（P 〈0.05或 P 〈0.01）；B组降压平稳后20 min 时点 HR低于对照组；硝酸甘油用量低于 A组,两组比较差异有统计学意义（P〈0.05或P 〈0.0 1）；两组术中出血量、手术时间比较差异无统计学意义（P〉0.05）。结论：乌拉地尔联合硝酸甘油控制性降压用于 FESS安全有效,术中 HR较平稳,未见明显 ECG ST-T的改变。Objective：To explore the effect urapidil combined with nitroglycerin on heart rate and ECG ST-T segment during the course of nasal endoscopy for the purpose of control hypertension.Methods：We ran-domly and equally divided 60 cases nasal endoscopy patients（ASA degree Ⅰ-Ⅱ）into control group（A group）and test group（B group）,we used urapidil only in A group and combined with nitroglycerin in B group. We use endotracheal incubation of general anesthesia for all the patients,and continuously moni-tored mean artery pressure（MAP）,heart rate（HR）,electrocardiogram（ECG）,oxygen saturation of blood （SpO2 ）and end tidal carbon dioxide pressure（PET CO2 ）during the course of operation for four time slot, which is T0 （before anesthesia）,T1 （before controlled hypotention）,T2 （blood pressure stable for 20 mi-nutes）and T3 （after stopping depressurization for 20 minutes）.For the tow groups,we control pressure to the level of 70 percent of basis blood pressure.We recorded the changes of MAP,ST-T segment,SPO2 , operation time,blood lose,urine volume and the dosage of nitroglycerin before depressurization,blood pressure stable for 20 minutes and after stopping depressurization for 20 minutes.Results：In A group,all patient HR is higher than that before operation,and there appeared change of ST-T segment in 1 1 cases, which recovered after stopping depressurization for 20 minutes.But in B group ,there appeared no changes of ST-T segment,HR after blood pressure stable for 20 minutes is lower than that of A group,and dosage of nitroglycerin are lower than that of A group,which have statistical significance.there was no difference of blood lose and operation time between in two group （P〉0.05）.Conclusion：It is safe and effective to control hypertension of urapidil combined with nitroglyc-erin in FESS,and with advantage of no heart function change,stable hemodynamic with no significant change on ECG ST-T.

关 键 词：乌拉地尔 硝酸甘油 功能性鼻内镜术 控制性降压 心率 心电图 ST-T改变 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]