脊柱肿瘤手术中应用硝酸甘油复合艾司洛尔控制性降压的研究

目的对比评价脊柱肿瘤手术中应用硝酸甘油复合艾司洛尔行控制性降压麻醉的效果。方法选择行脊柱肿瘤切除手术患者30例，随机分为3组，每组10例。对照组（A组）：不实施控制性降压，仅输注生理盐水；硝酸甘油组（B组）、持续输注硝酸甘油，起始速率2.5μg/(kg· min)；硝酸甘油、艾司洛尔联合组（C组）：持续输注硝酸甘油和艾司洛尔混合液（硝酸甘油∶艾司洛尔=1∶5），硝酸甘油起始速率为2.5μg/(kg· min)，艾司洛尔速率12.5μg/(kg·min)。降至目标血压（平均动脉血压60～70mmHg）后，调整药物剂量使平均动脉血压（MAP）维持在此范围至手术结束。分别记录降压前、降至目标血压时、降至目标血压后30min、降压停止时及术毕时的MAP、心率（HR）、中心静脉血压（CVP）。并监测手术时间、出血量、输血例数、尿量、术后伤口引流量。结果B组和C组的术中出血量、输血例数均少于A组（P＜0.05），C组手术时间少于A组（P＜0.05），B组和C组MAP的下降均显著低于降压前（P＜0.01），A组和B组降压期间的HR比降压前明显增快（P＜0.05），降压期间C组的HR显著低于B组（P＜0.05）。结论硝酸甘油复合艾司洛尔控制性降压麻醉方法应用于脊柱肿瘤手术安全、有效，明显减少术中出血量，缩短手术时间，且防止反射性心率增快。

Nitroglycerin combined with esmolol in controlled hypotention in spinal tumor surgery

To compare the anesthesia effects of nitroglycerin and esmolol in inducing controlled hypotention during spinal surgery. MethodsThirty patients undergoing elective spinal tumor surgery were randomly divided into three groups(n=10）: the control group(A), the nitroglycerin group(B) and the nitroglycerin+esmolol group(C). Group A only received normal saline without controlled hypotention, group B initially received nitroglycerin at 2.5μg/(kg·min) and group C initially received nitroglycerin［2.5μg/(kg·min) ］and esmolol［12.5μg/(kg·min)］. The nitroglycerin dosage was adjusted to maintain the MAP level at 60 70 mmHg in groups B and C. Hemodynamic parameters were recorded before controlled hypotention, just at the controlled hypotention, 30?min after controlled hypotention, at the end of controlled hypotention and at the end of the operations. Also the operation time, intra operative blood loss, blood transfusion amounts and post operative drainage from the wound were recorded. ResultsThe intra operative blood loss and blood transfusion cases in groups B and C were much less than those in group A（P＜0.05）. The MAP level of groups B and C significantly decreased during controlled hypotention（P＜0.01）. The HR level of group B significantly increased during controlled hypotention（P＜0.05）and of group C was less than that in group B （P＜0.05）. The duration of the operation was significantly shorter in group C than in group A.