硝酸甘油联合地尔硫革用于鼻内镜术中控制性降压的临床观察

目的：观察硝酸甘油联合地尔硫革在鼻内镜术中控制性降压的效果及对血流动力学的影响。方法：选择择期行鼻内镜手术的患者60例，随机均分为A组（未降压）、B组（硝酸甘油）、C组（硝酸甘油＋地尔硫革），比较各组麻醉前，插管后，降压后15、30min和降压结束后10min的心率（HR）、平均动脉压（MAP）、手术时间和出血量，评估术野质量。结果：B、C组术中出血量、手术时间和术野质量评分均较A组减少，差异有统计学意义（P〈0．05）；控制性降压后15、30min，B、C组MAP均较A组显著降低，B组HR较A组显著增加，C组HR较A、B组显著降低，差异均有统计学意义（P〈0．05）。2组患者均未见严重不良反应发生。结论：硝酸甘油联合地尔硫革控制性降压应用于鼻内镜手术，可实现平稳降压，与硝酸甘油比较，可防止反射性的HR增快。

Clinical Observation of Nitroglycerin Combined with Diltiazem on Controlled Hypotension during Endoscopic Nasal Surgery

OBJECTIVE： To observe the effect of nitroglycerin and diltiazem on hemodynamics on controlled hypotension during endoscopic nasal surgery. METHODS： 60 ASA I - II patients undergoing selective endoscopic nasal surgery were randomly assigned into group A （non-hypotensive）, group B （nitroglycerin group） and group C （nitroglycerin＋diltiazem group） with 20 cas- es in each group. HR, mean artery pressure （MAP）, operation time and bleeding capacity were compared among 3 groups before anaesthesia, after intubation, 15 min 30 min after hypotension, 10 minutes after the end of hypotension. The surgical field quality （SSFQ） were evaluated. RESULTS： The bleeding capacity, operation time and SSFQ in group B and C were significantly decreased, compared with group A, there was statistical significance （P〈0.05）. 15, 30 minutes after controlled hypotension, the MAP in group B or C were significantly lower than that in group A, HR in group B were significantly higher than that in group A, HR in group C were significantly lower than that in group A or B, there was statistical significance （P〈0.05）. There was no signif- icant ADR found in both groups. CONCLUSION： The controlled hypotension with nitroglycerin and diltiazem in endoscopic nasal surgery can decrease blood pressure smoothly and prevent reflex enhancement of HR.