硝酸甘油复合艾司洛尔控制性降压在正颌手术中的应用  

Clinical efficacy of nitroglycerin combined with esmolol in controlled hypotension during orthognathic surgery

作　　者：余伊[1] 刘莉[1] 严恩石[1] 吴波[1] 尹楠[1] 孙强[1] YU Yi;LIU Li;YAN Enshi;WU Bo;YIN Nan;SUN Qiang(Department of Anesthesiology, Jiangsu Key Laboratory of Oral Diseases, Nanjing Medical University,Affiliated Hospital of Stomatology, Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学口腔疾病研究江苏省重点实验室南京医科大学附属口腔医院麻醉科,江苏南京210029

出　　处：《口腔医学》2018年第4期333-336,共4页Stomatology

摘　　要：目的观察硝酸甘油复合艾司洛尔控制性降压在正颌手术中的降压效果。方法选择ASAⅠ或Ⅱ级,择期行正颌手术患者60例,采用随机数字表法均分为硝酸甘油组(N组)和硝酸甘油复合艾司洛尔组(NE组)。手术开始离断上颌骨前2min开始降压,两组硝酸甘油初始剂量4μg·kg-1·min-1,NE组同时泵注艾司洛尔150μg·kg-1·min-1,降压维持到上颌骨离断完成时停止。观察并记录各组患者降压前即刻(T0)、达到目标血压时(T1)、达到目标血压后5 min(T2)、停止降压后5min(T3)、停止降压后10 min(T4)的MAP、HR和CVP。于术前、术毕检测Hb、Hct含量,计算出血量;记录硝酸甘油用量和截骨手术时间。结果与N组相比,NE组HR在T1,T2,T3时明显降低,MAP在T1、T3、T4时明显降低,截骨手术时间缩短,硝酸甘油用量减少(P<0.05),两组患者出血量,CVP差异无统计学意义。结论与单纯使用硝酸甘油相比,硝酸甘油复合艾司洛尔能够减少硝酸甘油用量,缩短截骨手术时间,抑制硝酸甘油引起的反射性心率增快,从而更能满足正颌手术的需要。Objective To observe the clinical efficacy of nitroglycerin combined with esmolol in controlled hypotension during orthognathic surgery. Methods Sixty elderly,ASAⅠ-Ⅱ,patients who was to undergo orthognathic surgery were selected and randomly divided into two groups,according to random number table. In Group N,nitroglycerin was used alone during operation,while in Group NE,nitroglycerin combined with esmolol was used. Nitroglycerin of both group started from 4 μg·kg-1·min-1,esmolol started from150 μg·kg-1·min-1. Controlled hypotension started 2 min before the osteotomy,stopped at the separation of maxillary. MAP,HR and CVP were recorded immediately before controlled hypotension（ T0）,at the goal of controlled hypotension（ T1）,5 min after achieving the goal（ T2）,5 min（ T3） and 10 min（ T4） after stopping controlled hypotension. The contents of hemoglobin and hematokrit before and after the operation were detected,the amount of bleeding was calculated,and the amount of nitroglycerin and the operation time were recorded. Results Compared with Group N,HR significantly decreased at T1 to T3,MAP significantly decreased at T1,T3 and T4,the operation time was shorter,the amount of nitroglycerin was less（ P〈0.05） in Group NE. The amount of bleeding and CVP had no statistically significant difference between two groups. Conclusions Nitroglycerin combined with esmolol in controlled hypotension is useful to shorten the amount of nitroglycerin,reduce the operative time,inhibit tachycardiac responses caused by nitroglycerin,so that it can meet the need of orthognathic surgery better.

关 键 词：控制性降压 硝酸甘油 艾司洛尔 

分 类 号：R782.23[医药卫生—口腔医学] R614.2[医药卫生—临床医学]