髋部手术全麻患者硝普钠或尼卡地平控制性降压的安全性

目的评价髋部手术全麻患者硝普钠或尼卡地平控制性降压的安全性。方法择期行髋部手术全麻患者20例,随机分为Ⅰ组(硝普钠组,n=10)和Ⅱ组(尼卡地平组,n=10)。在静吸复合全身麻醉下,分别于手术开始时静脉输注硝普钠(0．5-8 μg·kg-1·min-1)或尼卡地平(1-8μg·kg-1· min-1),使平均动脉压降至55-65 mm Hg,并维持此水平至术毕。用食管超声多普勒血流监测仪监测血液动力学变化,记录降压前即刻(基础值)、降压15 min、30 min、60 min及停降压药后15 min、30 min时主动脉血流量(ABF)、心输出量(CO)、主动脉每搏流量(SVa)、左室射血时间(LVETi)、左室射血峰速度 (PV)、血流加速度(Acc)、主动脉内全身血管阻力(TSVRa);记录术中出血量、输液量、尿量、术后伤口引流量及需异体输血情况;于术前和术后24 h抽取静脉血,测定肝肾功能。结果与基础值比较,两组降压过程中及停降压药后MAP及TSVRa降低,降压过程中HR增快,Ⅰ组降压过程中CVP降低, ABF、CO升高,LVETi延长(P<0．05)。与Ⅱ组比较,Ⅰ组停降压药后30 min时MAP升高,LVETi延长, 降压时间及升压时间缩短,术中出血量和异体输血率降低(P<0．05或O．01)。两种药物对肝、肾功能无明显影响。结论硝普钠及尼卡地平均可安全地用于全身麻醉患者控制性降压,但硝普钠降压的可控性优于尼卡地平,且能更有效地减少术中出血。     

雷米芬太尼-硝普钠用于鼻内镜手术控制性降压

目的研究雷米芬太尼或雷米芬太尼-硝普钠用于鼻内镜手术控制性降压的效果及对血浆内分泌激素的影响。方法48例择期全麻下行鼻内镜手术病人,采用硝普钠（N组）、雷米芬太尼（R组）或雷米芬太尼复合微量硝普钠（RN组）控制性降压,维持MAP在60～70mmHg。记录降压前即刻（T0）、降压30min（T1）和停降压待BP自然恢复稳定后（T2）时的MAP、HR,并在以上各时点抽取动脉血测定血浆皮质醇（Cor）、血管紧张素Ⅱ（A-Ⅱ）、白细胞介素-6（IL-6）和血糖（BG）的浓度。结果R组17例（70．8％）单纯用雷米芬太尼可达到降压目的。降压期间,N组HR明显增快（P〈0．05）,停降压后出现反跳性高血压;R和RN组HR减慢（P〈0．05）,停降压后MAP回复至降压前水平。降压后BG、Cor、A-Ⅱ的浓度和T0时相比,N组明显增高（P〈0．05）;三组IL-6的浓度均明显升高（P〈0,05）,N组升高幅度大于R、RN组（P〈0．05）。结论雷米芬太尼用于鼻内镜手术行控制性降压安全可行,有效抑制了机体的应激反应;复合微量硝普钠能减少雷米芬太尼的用量,降压效果可靠。     

鼻内窥镜手术患者硝普钠控制性降压期间肺内分流的变化

目的观察鼻内窥镜手术患者硝普钠（SNP）控制性降压期间肺内分流的变化。方法Ⅱ-Ⅳ期鼻窦炎患者40例，择期行鼻内窥镜手术，ASAI或Ⅱ级，术中用SNP行控制性降压，使平均动脉压降低原水平的30％-40％。分别于SNP输注前即刻（降压前）、降压30、60min、停止SNP输注复压后20min时分别取动脉血和右心室血，进行血气分析，并计算肺内分流率（Qs／Qt），持续监测血液动力学指标。结果与降压前比较，降压30、60min时Qs／Qt增加（P＜0．01）；与降压30min比较，降压60min时Qs／Qt差异无统计学意义（P＞0．05），复压后20min Qs／Qt减至降压前水平。降压期间心率增快，心搏量及心输出量降低（P＜0．05）。结论鼻内窥镜手术患者SNP控制性降压期间虽然肺内分流增加，循环功能降低，但并未发生低氧血症，且复压后迅速恢复正常，其安全性是可靠的。     

尼卡地平控制性降压的效应及其对内分泌系统的影响

目的：观察尼卡地平控制性降压的效能及对内分泌系统的影响。方法：选择２０例择期手术的骨肿瘤病人，在手术开始后，经中心静脉通路推注单次剂最Ｎｉｃａｒ ０．０１－０．０２ｍｇ／ｋｇ，继以１－４μｇ．ｋｇ＾－１．ｍｉｎ＾－１滴注维持。结果：Ｎｉｃａｒ控制性降压期间，循环指标稳定，降压期间Ｎｉｃａｒ的调节次数为１．５±０．７次／小时，达到目标血压仅需４７±３１秒，停药后血压恢复至降压前所需时间为４０±１６分     

可乐定对硝普钠控制性降压的影响

观察可乐定对硝普钠控制性降压的影响。２４例ＡＳＡⅠ￣Ⅱ级择期颅脑手术病人随机分为：Ｉ组（对照组）；Ⅱ组（可乐定组），术前口服可乐定５μｇ／ｋｇ。每组１２例。用０．０１％硝普钠液使ＭＡＰ降低４０％。结果，Ⅱ组血压易于下降和维持，停止降压后Ⅱ组ＭＡＰ明显低于Ｉ组（Ｐ〈０．０５）；Ⅱ组各个时点ＨＲ明显慢于Ｉ组（Ｐ〈０．０５或Ｐ〈０．０１）；Ⅱ组滴注硝普钠后全血氰化物（ＣＮ）浓度明显低于Ｉ组（Ｐ〈０．０１     

硝普钠-艾司洛尔用于神经外科控制性降压的临床研究

目的　研究硝普钠或硝普钠 艾司洛尔用于轻或中度颅内高压患者控制性降压对脑氧代谢和颅内压的影响。方法　 1 8例颅内压轻度增高的颅内肿瘤患者 ,在持续丙泊酚静脉麻醉 (目标血浓度 5 μg/ml)下行开颅手术。采用硝普钠或硝普钠 艾司洛尔控制性降压至动脉压 6 4～ 6 8/ 4 0～4 5mmHg,持续 1h。监测降压前后及降压期间颈内静脉血氧饱和度及动脉氧分压、颅内压、心率、血压变化。结果　在丙泊酚全身麻醉下硝普钠降压不引起颅内压增高 ,脑氧代谢良好。合并使用艾司洛尔 5 0 μg·kg 1 ·min 1 ,有助于维持较低的颅内压 ,并可减慢心率 ,防止硝普钠停药后反跳性高血压 ,硝普钠用量亦减少约 4 5 %。结论　硝普钠降压用于丙泊酚静脉麻醉的神经外科病人 ,脑氧代谢良好 ,联合使用硝普钠、艾司洛尔优于单纯使用硝普钠     

尼卡地平控制性降压对家犬脊髓诱发电位的影响

目的观察尼卡地平控制性降压对家犬脊髓诱发电位（SCEPs）的影响,探讨脊柱手术麻醉中尼卡地平控制性降压的安全性。方法成年杂种犬6只,体重12．0～15．5kg,用2．5o,4硫喷妥钠行麻醉诱导并维持麻醉。股动脉置管监测MAP。以尼卡地平8μg·kg^-1·min^-1持续静脉注射进行控制性降压,降压标准为基础MAP的40％。以日本光电诱发电位监测仪测定SCEPs。结果MAP平均下降幅度为42．9％,控制性降压后体感诱发电位（SEP）波幅及运动诱发电位（MEP）波幅差异无统计学意义。结论尼卡地平控制性降压对SCEPs影响较小,可安全用于脊髓手术。     

艾司洛尔复合硝普钠控制性降压用于关节镜下肩袖修补术的临床观察

目的研究艾司洛尔复合硝普钠控制性降压用于半坐卧位肩关节镜下肩袖修补的可行性及安全性。方法 2010年7月～2011年5月,选择50例单侧肩袖撕裂行关节镜手术患者,按病例单双号分为2组,每组25例。S组（单纯硝普钠组）用微量泵以0.5～5.0μg/（kg.min）速率输注硝普钠,ES组（艾司洛尔＋硝普钠组）在泵注硝普钠的同时泵注艾司洛尔150～300μg/（kg.min）。2组平均动脉压均缓慢降至55～65 mm Hg。监测降压前,降压后5 min、15 min、45 min,停药后5min、10 min的平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SpO2）、呼气末CO2分压（PETCO2）及颈内静脉球部血氧含量（SjvO2）,记录关节冲洗液量、尿量、硝普钠用量、手术时间、术中术野质量评分等指标。结果 2组降压后HR差异有显著性（P〈0.01）,S组伴HR升高,而ES组在降低MAP的同时可减慢HR。停药后,S组反跳性引起HR、MAP增高,ES组停药反跳不明显,2组间差异有显著性（P〈0.01）。2组降压后SjvO2有轻微下降,但均在正常范围内,差异无显著性（P〉0.05）。ES组关节冲洗液量、硝普钠用量及手术时间少于S组,术野评分优于S组,差异有显著性（P〈0.01）。结论硝普钠-艾司洛尔联合应用可使控制性降压前后的机体生理变化更趋于平稳,减少硝普钠用量,使术野更清晰,缩短手术时间,减少关节冲洗液量,脑氧代谢良好。     

Renin Release during Controlled Hypotension with Sodium Nitroprusside, Nitroglycerin and Adenosine: A Comparative Study in the Dog

The haemodynamic effects of i.v. infusions of sodium nitroprusside (SNP), nitroglycerin (TNG), and adenosine were studied in dogs in parallel with quantitative determinations of plasma renin activity (PRA) by radioimmunoassay. The drugs were given for controlled hypotension, and the mean arterial blood pressure (MABP) was decreased to approximately 50 mmHg (6.7 kPa). Arterial blood samples for PRA were collected at 10-min intervals. During the last interval the dogs were subjected to haemorrhagic shock. SNP-induced hypotension could be maintained only with a stepwise increase in infusion rate, from 11.8 to 16.0 micrograms X kg-1 X min-1 (P less than 0.05). TNG could not produce the desired blood pressure level, but gradually increasing doses induced a gradually decreasing MABP (80-60 mmHg) (10.7-8.0 kPa). During adenosine-induced hypotension, a perfectly stable blood pressure level was maintained without dose adjustments. Both SNP and TNG induced blood pressure-dependent increases in PRA, while no changes in PRA were seen during adenosine-induced hypotension. Nor could haemorrhagic shock, which induced further increases in PRA during SNP- and TNG-induced hypotension, alter PRA during adenosine infusions. We conclude that adenosine differs markedly from conventional hypotensive drugs such as SNP and TNG with respect to stability of action and dose requirements, and that this stability is related to an inhibited increase in renin release.     

Haemodynamic Changes during Sodium Nitroprusside Induced Hypotension and Halothane/Nitrous Oxide Anaesthesia

The haemodynamic effects of nitroprusside (SNP) were studied in six patients undergoing surgery for intracranial aneurysm under controlled hypotension in endotracheal anaesthesia with halothane-nitrous oxide during hypocapnia. Mean arterial pressure was reduced with SNP from mean 12.25 kPa to mean 8.29 kPa (32%). There were concomitant statistically significant decreases in systemic vascular resistance (-21%), cardiac index (-17%), stroke index (-23%), pulmonary arterial mean pressure (-27%) and pulmonary capillary wedge pressure (-27%). Heart rate, central venous pressure and pulmonary vascular resistance did not change significantly. After the infusion of SNP was discontinued all parameters, except cardiac index and heart rate, returned to values not significantly different from the control values. The hypotension induced by SNP resulted from reductions in cardiac index and systemic vascular resistance. The reduction in cardiac index did not reach a critical level in any of the patients.     

正颌手术中尼卡地平行控制性降压对术后全身炎症反应综合征的影响

目的 观察尼卡地平用于正颌术中控制性降压对术后全身炎症反应综合征（SIRS）的影响。方法选取2019年10月-2023年4月于我院拟行正颌手术的199例患者为研究对象,随机分为加深麻醉组（P组）98例、尼卡地平组（N组）101例。P组采用增加丙泊酚泵注剂量行控制性降压,N组复合泵注尼卡地平行控制性降压,目标将MAP降至65 mmHg以下,比较两组术后第1天SIRS发生率,术中不同时刻平均动脉压（MAP）、心率（HR）和麻醉深度患者状态指数（PSI）、术中麻醉用药剂量及拔管时间。结果 N组术后第1天SIRS发生率为33.66%,低于P组的40.82%,但差异无统计学意义（P ＞0.05）;两组T1~T8时刻MAP比较,差异无统计学意义（P＞0.05）;N组T2~T7时刻HR高于P组（P ＜0.05）;除T7时刻外,N组T2~T8时刻适宜麻醉深度例数多于P组,麻醉过深例数少于P组（P ＜0.05）;N组术中丙泊酚使用量小于P组,拔管时间短于P组（P＜0.05）。结论 尼卡地平用于正颌术中控制性降压效果满意,且有助于维持合适麻醉深度,缩短拔管时间,但对术后全身炎症反应综合征发生率无明显影响。     

Central and Splanchnic Haemodynamics in the Dog During Controlled Hypotension with Sodium Nitroprusside

The effects of controlled hypotension induced by sodium nitroprusside (SNP) on central and splanchnic haemodynamics were studied in ten artificially ventilated dogs under neurolept anaesthesia. SNP was given intravenously as a continuous infusion in order to maintain a mean arterial blood pressure (MABP) of about 50 mmHg. Observations were made before (control) and at 20 and 60 min after the start of the SNP infusion. The mean SNP dosage was 13.7 micrograms X kg-1 X min-1. Systemic vascular resistance (SVR) decreased by 47%. After 20 min there was a 17% decrease in cardiac output, while the hepatic arterial blood flow was diminished by 39%, and portal venous blood flow by 16%. Cardiac output and portal venous blood flow tended to return towards control values at 60 min, while the hepatic arterial blood flow remained depressed. The total oxygen uptake was unaltered after 20 min, but slightly decreased after 60 min. There were no changes in hepatic or preportal tissue oxygen consumption, nor in hepatic lactate uptake. It is concluded that SNP-induced hypotension was achieved primarily by a profound reduction of SVR, and initially also by a slight decrease in cardiac output. Although splanchnic and hepatic blood flows decreased, there were no signs of hypoxia in the preportal tissues or in the liver.     

Controlled Hypotension with Sodium Nitroprusside: Effects on Cerebral Blood Flow and Cerebral Venous Blood Gases in Patients Operated for Cerebral Aneurysms

The effect on cerebral haemodynamics of arterial hypotension induced by sodium nitroprusside infusion was studied in nine patients at the end of operations for intracranial aneurysms under N2O-O2-halothane anaesthesia. Cerebral blood flow (CBF), using the intraarterial 133Xe injection method, and cerebral jugular venous blood gases were monitored before, during and after the induced hypotension. CBF and jugular venous oxygen tension (PvO2) remained constant during the hypotensive period. Following its termination, a 13% increase in CBF occurred (P less than 0.05) and PvO2 showed the same trend, a 5% increase (P less than 0.30). Regional CBF recordings (rCBF) in 16 small areas within the cerebral hemisphere were obtained at each measurement. In four of the patients, rCBF abnormalities were present in the form of hyperaemic regions, probably induced by the operation or the disease itself. The focal abnormalities were not accentuated during hypotension nor were ischaemic regions disclosed. It is concluded that sodium nitroprusside has only a minor influence on cerebral haemodynamics in the anaesthetized state.     

Thiopental Loading During Controlled Hypotension for Intracranial Aneurysm Surgery

In this study we report our clinical experience with supplementary thiopental loading, based on 30 patients undergoing surgery for intracranial aneurysm after a recent episode of subarachnoid haemorrhage. As standard procedure we used pentobarbitone induction, pancuronium relaxation, endotracheal intubation, maintenance with halothane 0.5%, N₂O 66% in oxygen, fentanyl, and moderate hypocapnia. A thiopental load of up to 20 mg.kg^-1 was supplied while the aneurysm was approached. Satisfactory and well-controlled hypotension was obtained in five cases after thiopental alone, and after thiopental and sodium nitroprusside (SNP) ( ± s.d.) 1.3 ± 0.9 μg-kg^-1-min^-1 in the remaining 25 patients. No ECG sign of myocardial ischaemia was observed. One disadvantage was a prolonged recovery period, which in some cases necessitated controlled ventilation for some hours. We conclude that thiopental loading can be used safely as a supplement to neuroanaesthesia for aneurysm surgery.     

Circulatory Effects of Haemorrhage during Sodium Nitroprusside Induced Hypotension A Study in the Rat

The haemodynamic changes induced by acute moderate blood loss were investigated in rats during normotensive halothane anaesthesia and during sodium-nitroprusside-induced hypotensive anaesthesia, respectively. Following haemorrhage in the normotensive group, mean arterial blood pressure, heart rate and left cardiac work decreased. Cardiac output was reduced non-significantly. Blood flow was redistributed to favour cerebral, coronary, renal and hepatic circulation, mainly at the expense of blood flow to the carcass. Following haemorrhage in the hypotensive group, cardiac output increased significantly. Mean arterial pressure, heart rate and left cardiac work were unchanged. Absolute values for cerebral, coronary, renal and hepatic blood flow were maintained or even increased, while blood flow to the carcass was unchanged.     

控制性降压联合穴位电刺激对术后认知功能障碍的影响

目的：探讨七氟烷麻醉下以硝酸甘油行控制性降压联合穴位电刺激对术后认知功能障碍的影响。方法：选择ASAⅠ～Ⅲ级,45～65岁行单节段腰椎切开复位内固定手术患者75例,随机分为穴位刺激联合硝酸甘油控制性降压组（T组,n=36）及单纯硝酸甘油控制性降压组（N组,n=39）,分别给予相应的治疗。结果：术后1、3dT组术后认知功能障碍发生率较N组明显降低（P〈0.05,P〈0.01）;5d发生率两组无显著差异（P〉0.05）。术后各时间点两组患者血清S-100β浓度均较术前升高（P〈0.05,P〈0.01）。术后1、3dT组血清S-100β较N组明显减低（P〈0.05,P〈0.01）,术后5d两组无显著差异。结论：七氟烷麻醉下行控制性降压联合经皮穴位电刺激可降低术后认知功能障碍的发生率。     

靶控输注瑞芬太尼联合七氟烷用于腰椎手术控制性降压的前瞻性随机对照研究

目的 观察靶控输注(target controlled infusion,TCI)瑞芬太尼联合七氟烷控制性降压应用于腰椎手术的安全性和有效性.方法 2009年12月-2011年8月,ASA I～Ⅱ级择期行腰椎减压内固定手术60例,随机分为硝酸甘油组和瑞芬太尼组,每组30例.手术切皮前15 min开始实施控制性降压,硝酸...