静注艾司洛尔对乳腺癌根治术局部注射肾上腺素患者的血流动力学影响

目的：观察静注艾司洛尔对乳腺癌根治术局部注射肾上腺素患者血流动力学的影响。方法：选择120例行乳腺癌根治术患者，其中80例血压正常，随机分为A、B、c、D4组。另外40例为术前诊断高血压病的患者，随机分为E、F2组。选择A组和E组分别为对照组，不使用。肾上腺素或艾司洛尔，B组分离皮瓣时于皮下注射2ug·ml-1的。肾上腺素80ml，C组在皮下注射80ml的肾上腺素的同时静脉输注1％的艾司洛尔1mg·kg-1，D组和F组只在切皮时静脉输注l％的艾司洛尔1mg·kg-1，不使用肾上腺素。监测并记录患者手术当天在病房的血压、心率，视为基础值（T0），并记录麻醉前（T1）、麻醉后（T2）、皮下注射肾上腺素或静脉输注艾司洛尔时（T3）（不使用组记录切皮时）、注射肾上腺素或艾司洛尔或切皮5min后（T4）、10min后（T5）、15min后（T6）、1h后（T7）的数值。结果：B组血压、心率（T4—T6）较A组明显升高（P〈0．05）；C组血压、心率（T4～T6）较B组明显降低（P〈0．05）；D组与A组（T3～T7）相比无统计学差异（P〉0．05）；F组血压、心率（T4-L）较E组明显下降（P〈0．05）。结论：行乳腺癌根治术分离皮瓣时，局部注射肾上腺素同时静脉输注艾司洛尔可以显著抑制肾上腺素所致血压、心率上升，维持患者围术期血流动力学的平稳，且对心血管功能正常的患者无明显影响。

The hemodynamic effects of esmolol in patients undergoing subcutaneous injection of epinephrine in radical mastectomy

Objective： To investigate the hemodynamic effects of esmolol in patients with radical mastectomy undergoing subcutaneous injection of epinephrine. Methods： 120 patients undergoing radical mas- tectomy surgery. 80 cases with normal blood pressure were randomly divided into 4 groups （ A,B,C and D）. 40 patients with hypertension were randomly divided into 2 groups （E and F）.Group A and E were control groups which without epinephrine and esmolol. Group B and C of which skin flap was dissected following subcutaneous injection of epinephrine （2ug. ml-1） 80 ml and group C was combined with esmolol （1%） 1 mg. kg-1 intravenous. Group D and F were only administered esmolol 1 mg. kg-1 during incision. BP and HR as basic values were recorded in ward（T0）, preanesthesia （T1）, after induction of anesthesia （T2）, injecting epinephrine,esmolol or incision（T3）, following by four time points,respectively 5 min later, 10 min later（T5）, 15 min later（T6） and 1 h later（T7）. Results： The BP and HR of group B （T4-T6）were higher obviously than those of group A（ P〈0.05）;The BP and HR of group C （T4-T6）were lower obviously than group B（ P〈0.05）; there was no significant difference between group A and D （T3-T7）;the BP and HR of group F （T4-T6） were significant lower than those of group E（P〈0.05）. Conclusion： Patients with radical mastectomy undergoing skin flap dissection combinated with esmolol iv gtt can effectively reduce the BP and HR induced by epinephrine subcutaneously; make the hemodynamics of patients more stable and have no significant influences on patients with ortheo-arteriotony.