库存悬浮红细胞洗涤处理对婴幼儿体外循环后炎症因子水平的影响

目的观察库存悬浮红细胞应用血液回收机洗涤处理后预充对婴幼儿体外循环后炎症因子水平的影响。方法选取室间隔缺损择期手术患儿40名,随机分成对照组A(Group A)实验组B(Group B),A组对CPB预充用库存悬浮红细胞不进行任何处理,B组应用血液回收机对库存悬浮红细胞进行洗涤处理后再预充。分别在体外循环开始前(T1)、体外循环结束时(T2)、术后2 h(T3)、术后12 h(T4)、术后24 h(T5)取动脉血标本行TNF-α、IL-6、IL-8、IL-10和C-反应蛋白(CRP)检测,比较2组之间差异。结果 2组患儿的血TNF-α、IL-6、IL-8、IL-10和CRP在T2、T3、T4均呈持续升高趋势并在T5恢复至略高于术前水平;TNF-α、IL-8在术后整个过程实验组均显著低于对照组(P0.05);IL-6、IL-10在T5实验组和对照组差别无统计学意义(P0.05);CRP T3至T5显著升高无下降趋势且实验组显著低于对照组(P0.05)结论血液回收机洗涤预充用库存悬浮红细胞可降低婴幼儿体外循环后机体炎症因子水平,减轻全身炎症反应,促进患儿术后恢复。     

术中自体血液回收249例临床总结

目的 观察术中自体血液回收在各种手术中的应用。方法 应用COBE BRAT2自体血液回收机对249例行各种手术的病人进行自体血液回收,经过抗凝、回收、过滤、洗涤程序处理后再回输给病人,并记录每例病人的回收血量和回收血的血细胞比容。结果 249例病人术中每例回收浓缩红细胞悬液100～2700ml不等,平均每例回收520±347ml,共129566ml。经血液回收机处理后获得的血液,血细胞比容>37％的有174例,每例回收浓缩红细胞悬液150～2700ml不等,平均每例回收608±371ml,共105830ml。结论 术中自体血液回收是安全、有效的自体输血方式,节省了大量的库血,减少了输血并发症。     

体外循环预充还原型谷胱甘肽对非紫绀型先心病术中心肌的保护作用

目的:观察体外循环预充还原型谷胱甘肽对非紫绀型先心病术中的心肌保护作用。方法:将30例非紫绀型先天性心脏病患儿随机分为两组,实验组(n=15)在体外循环预充液中加入还原型谷胱甘肽(剂量20mg/kg),对照组(n=15)在体外循环预充液中加入等量的盐水。于术前、主动脉开放2、12、24、48h五个时间采患儿动或静脉血,分别测乳酸脱氢酶(LDH)、血清肌酸激酶(CK)、血清肌酸激酶同工酶(CK-MB)、天门冬氨酸氨基转移酶(AST)。结果:实验组血清LDH、CK在主动脉开放12、24、48h较相同时间的对照组有显著减低(P<0.05或0.01);实验组血清AST在主动脉开放2、12、24、48h较相同时间的对照组有显著减低(P<0.05或0.01);实验组血清CK-MB在主动脉开放2、12、24h较相同时间的对照组有显著减低(P<0.05或0.01),差异具有统计学意义。结论:体外循环预充还原型谷胱甘肽对非紫绀型先心病术中具有心肌保护作用。     

颅脑手术中清洗后回收血液质量的研究

目的检验颅脑手术中血液回收机处理后回收血液的质量。方法20名颅脑疾患择期手术患者,应用自体-2000型血液回收机回收术野出血,经抗凝、过滤、离心及清洗后回输。测定血液回收机对收集血的处理过程中血小板、白细胞、K+和游离血红蛋白的清除率。用扫描电子显微镜对5份清洗后的血样及5U库存2周的红细胞悬液进行超微形态学检验,观察红细胞的形态。结果储血罐内收集血的溶血率达到(8.57±0.35)%,血液回收机的离心清洗过程中血小板、白细胞、K+和游离血红蛋白的清除率分别为:(85.4±7.3)%、(38.8±17.1)%、(90.4±4.4)%及(92.7±2.9)%。扫描电子显微镜下虽然可见回收血液中含有部分变形的红细胞,但红细胞的形态正常率仍达到(58.0±8.0)%。而库存2周的红细胞悬液中含有更多变形的红细胞(P<0.01)。结论在颅脑手术中收集的血液,溶血程度较重,但经血液回收机处理后,其质量较好。     

添加紫外线照射充氧血预充液对体外循环心脏瓣膜置换手术红细胞脂质过氧化的影响

目的:研究使用添加紫外线照射充氧血预充液对体外循环心脏瓣膜手术患者红细胞脂质过氧化的影响.方法:48例行体外循环心脏瓣膜置换手术患者,分为治疗组和对照组(各24例),治疗组于全身血液肝素化后通过锁骨下静脉按10 mL/kg体重采血或使用库存血细胞行紫外线照射并充氧后加入预充液,对照组使用等量生理盐水,两组预充液中其他成分相同,其他处理两组相同.两组均于麻醉诱导后、转机30min、开放主动脉30min、术后第1天采桡动脉血测定血浆脂质过氧化物(PLPO)、红细胞脂质过氧化物(ELPO)浓度和红细胞超氧化物歧化酶(ESOD)活性.结果:两组患者体外循环后PLPO、ELPO浓度均有明显上升,ESOD活性在开放主动脉30min后有所上升随后明显下降(P＜0.05),治疗组体外循环开始后各时间点PLPO,ELPO水平低于对照组,ESOD水平在开放主动脉后各时间点高于对照组(P＜0.05).结论:使用添加紫外线照射充氧血预充液具有减轻体外循环心脏瓣膜手术患者红细胞脂质过氧化作用.     

深圳市RhD阴性血液临床供应新模式的应用与探讨

目的探讨深圳市RhD阴性血液供应新模式,即"RhD阴性红细胞悬液动态库存法"的有效性和可行性。方法将实施"RhD阴性红细胞悬液动态库存法"前1年临床用量设定为对照组,实施后1年的临床用量设定为实验组,分别对2组数据进行统计分析。结果 RhD阴性血液的紧急用血量与急诊采集量在2组之间的差异具统计学意义(χ2=96.59,P<0.01),而总用血量和非紧急用血量之间的差异不具统计学意义(χ2=1.63,P>0.05)。结论 2008年后,深圳市RhD阴性血液临床用量比2008年前大幅度增长,"RhD阴性红细胞悬液动态库存法"对于保证临床紧急用血需求是有效且可行的。     

不同强度脉冲电磁场对小鼠血液流变学的影响

目的:探讨3种强度不同的脉冲电磁场对小鼠血液流变学指标的影响,以期为心血管疾病的预防和治疗提供新的思路。方法:将40只雄性小鼠随机分为4组(n=10),分别为磁场组和对照组。磁场组分别暴露于强度分别为10×10-4,20×10-4,30×10-4T的脉冲磁场下(f=15Hz),暴磁时间为6h/d;对照组饲养于线圈中,但不暴磁。10d后统一摘右眼取血,测定血细胞比容及全血高切、低切表观黏度。结果:磁场组血细胞比容、全血高切、低切表观黏度及红细胞聚集指数均明显低于对照组(P<0.05),其中以10×10-4T组各项指标犤(0.462±0.10)%,(5.976±0.31),(35.257±3.62)mPa·s,5.903±0.37犦降低最为显著(t=5.015-13.33,P<0.01)。结论:低强度脉冲电磁场可以降低血细胞比容及全血高切、低切表观黏度,可提高血液的流动性,改善微循环,有利于心脑血管疾病的预防和治疗。     

白细胞过滤器去除血液中肿瘤细胞及对红细胞的影响

目的研究白细胞过滤器清除血液回收机漂洗后血液中残存肿瘤细胞的效果,并观察过滤后红细胞的数量、形态及其脆性的改变。方法选择繁殖能力强,不易受损的细胞系肠肿瘤细胞(LOVO)和胃肿瘤细胞(SGC)进行体外培养,待细胞消化后制成单一细胞悬液;采集非肿瘤患者术野血液,经过滤、离心、漂洗收集浓缩红细胞。将细胞悬液中的肿瘤细胞计数后混入浓缩的红细胞中,混匀,再用血液回收机过滤、离心、漂洗,将漂洗后得到的浓缩红细胞用白细胞过滤器过滤,观察过滤对血样中肿瘤细胞的影响并与未经过滤处理的对照组进行比较,同时测定红细胞数、红细胞平均体积(MCV)、红细胞体积分布宽度变异(RDW)及红细胞渗透脆性,观察过滤对红细胞的影响。结果过滤后的血样中未发现肿瘤细胞,而对照组血样中可见到肿瘤细胞。培养14天后观察,经白细胞过滤器过滤后的血样未见肿瘤细胞生长,而对照组血样中有大量肿瘤细胞生长。过滤后的RBC、MCV、RDW和红细胞渗透脆性与对照组相比差异无显著性(P>0.05)。结论应用自体血液回收机配合白细胞过滤器,可有效去除血液中的肿瘤细胞,且对红细胞数量、形态及细胞膜无明显影响。     

血液回收机在Ⅱ类手术环境中应用的生物安全研究

目的研究血液回收机在Ⅱ类手术环境中应用的生物安全。方法采用平板暴露法,对50名患者,在手术前、中、手术结束时分别进行Ⅱ类手术室的空气监测,了解微生物的相关指标和回收血液成品的生物安全性。同时对血液回收机使用中的预冲液,洗涤废液和回收的浓缩红细胞进行微生物监测。观察回收浓缩红细胞的细胞形态完整性。比较回输自体血后患者与未使用自体血液回收机的患者白细胞数及体温。结果随手术时间的延长手术室空气中微生物数增加,与手术前比较有统计学差异(P<0.01)。经回收机洗涤后回收的浓缩红细胞微生物监测为零;细胞形态完整。术后患者白细胞数、体温与未使用血液回收机的对照组比较均无统计学差异(P>0.05)。50例手术平均回收血813ml,最大回收量2 755ml,最小回收量212ml。结论血液回收机在合格的Ⅱ类手术环境中可安全使用。     

术中自体血液回收与回输的应用研究

目的探讨自体血液回收技术在血液保护中的作用。方法运用ZITI-2000型血液回收机回收与回输自体血116例,监测术前及术中心率（HR）、平均动脉压（MAP）、动脉血氧饱和度（SpO2）、血红蛋白（Hb）、血细胞比容（Hct）、血小板计数（PLT）的变化,测定红细胞悬液的Hct,记录每例回收血量、回输血量和异体输血率。结果①平均每例回收血3379m l,回输血液1235m l,异体输血率为25.8%。②回输后HR、MAP、SpO2、Hb、Hct显著上升（P〈0.01）,PLT无显著变化。③回输红细胞悬液Hct为0.41～0.49。结论自体血液回收技术是一种安全、可靠的血液保护技术,可显著节约血源和减少异体输血。     

Effects of fresh versus old stored blood in the priming solution on whole blood lactate levels during paediatric cardiac surgery

It has been suggested that lactate levels may predict morbidity and mortality in paediatric patients during corrective open-heart surgery. Packed red blood cells (PRBC) are frequently necessary for priming the reservoir used in cardiopulmonary bypass (CPB). The storage of PRBC might cause a significant increase in lactate levels. The purpose of the present study was to quantify the increase in lactate levels in stored red blood cells over time and to compare lactate levels after transfusions of fresh (< or =12 days) versus old blood (>12 days) in 20 patients. We found an increase in lactate levels from 6.0 to 44.7mmol/L (mean 17.0+/-7.8 mmol/L) during storage. Lactate levels were also significantly higher after the onset of CPB in paediatric patients transfused with old blood than in patients transfused with fresh blood (1.43+0.36 versus 3.46+/-0.63, p=0.0006). Our results suggest that the higher lactate levels found after the initiation of CPB should be used with caution when assessing tissue hypoxia and predicting outcome.     

Reduction of hemodilution in small adults undergoing open heart surgery: a prospective, randomized trial

BACKGROUND: Given that there is an association between the degree of hemodilution during cardiopulmonary bypass (CPB) and postoperative complications, patients-outcome might be improved if the nadir hematocrit concentration is kept within an optimal range. Smaller patients are more likely to have a low hematocrit during CPB: this phenomenon may be related, at least partially, to the extreme hemodilution induced by a large fixed CPB priming volume. METHODS: Forty patients with a body surface area (BSA) < 1.7 m2 undergoing open heart operations were randomized to either standard CPB with full prime volume (control group) or reduced prime extracorporeal circuit and vacuum-assisted venous drainage (VAVD) (study group). RESULTS: There were no significant differences between the groups with respect to baseline characteristics, body surface area, hematologic profile and operative data. Clinical outcomes were similar. Nadir hematocrit and hemoglobin on bypass were significantly lower in the control group (22 +/- 2.3 vs. 24 +/- 2.5%, p < 0.02 and 7.4 +/- 0.7 vs. 8 +/- 0.9 g/dl, p < 0.04, respectively). Postoperative chest tube drainage was significantly higher in the control group (272 +/- 253 vs. 139 +/- 84 ml, p < 0.04). There was no difference in blood transfusion in the two groups (0.5 +/- 1.14 vs. 1.0 +/- 1.77 units of packed red blood cells (PRBC), p = 0.29). CONCLUSIONS: Lowering CPB priming volume by means of using a small oxygenator and vacuum-assisted venous drainage (VAVD) resulted in a significant decrease of intraoperative hemodilution. This technique should be strongly considered for patients with a small BSA (<1.7 m2) undergoing open heart surgery.     

A comparison of several variables of off-pump coronary artery bypass procedures versus myocardial revascularization utilizing cardiopulmonary bypass

An investigation was conducted to compare several variables of off-pump coronary artery bypass (OPCAB) procedures with those using cardiopulmonary bypass (CPB) for myocardial revascularization by two surgeons. The patients were divided into four groups: group 1 patients received CPB for their myocardial revascularization performed by surgeon A; group 2 patients received the OPCAB procedure performed by surgeon A; group 3 patients received CPB for their myocardial revascularization performed by surgeon B; and group 4 received the OPCAB procedure performed by surgeon B. The same anesthesia technique and postoperative management were employed for all patients in this study. The CPB procedures received the same perfusion circuit and conduct. Postoperative laboratory values, including hemoglobin, hematocrit and platelet counts for the OPCAB groups, were higher than the CPB groups. Chest tube drainage was similar for both the OPCAB and CPB groups, but postoperative urine outputs were significantly higher in the CPB groups for both surgeons. Positive fluid balance was statistically greater in the CPB groups compared to the OPCAB groups for both surgeons. Ventilator times, length of stay in the intensive care unit (ICU) and length of hospital stay were not statistically significant for the groups in this study. Postoperative weight gain for both surgeons was higher in the CPB groups. Intraoperative packed red blood cell (PRBC) usage for surgeon B was similar for both the OPCAB and CPB groups, but the OPCAB group for surgeon A had greater intraoperative PRBC usage than the CPB group.     

Processing of stored packed red blood cells using autotransfusion devices decreases potassium and microaggregates: a prospective, randomized, single-blinded in vitro study

The aim of the study was to compare the potential of autotransfusion devices to reduce non-infectious complications related to transfusion of long-stored packed red blood cells (PRBC; n= 57), such as changes in electrolytes, blood cells and the load of free microaggregates. Following a baseline measurement, a blood pool of three PRBC was divided into three equal volumes and washed with either the Haemonetics Cell Saver (HCS) or the continuous autotransfusion system (C.A.T.S), using the quality (CATS(quality)) and emergency (CATS(emergency)) mode. After the washing procedure, measurements for electrolytes, blood cells and free microaggregates were repeated (n= 19 each). Compared with baseline, the investigated autotransfusion devices reduced the median load of potassium (baseline: 52 mEq L(-1); HCS: 4 mEq L(-1); CATS(quality): 4 mEq L(-1); CATS(emergency): 17 mEq L(-1); each P < 0.001), restored a physiologic electrolyte balance and significantly decreased the load of leucocytes, glucose and protein. Whereas the quantity of microaggregates was not reduced by HCS, CATS(emergency) decreased the load of cell fragments below 7.8 microm (P < 0.05 vs. baseline). Using CATS(quality) decreased the load of cell fragments not only to a diameter below 7.8 microm (P < 0.001 vs. baseline) but also of microaggregates between 7.8 and 17.6 microm (P < 0.05 vs. baseline). In situations where long-stored PRBC have to be transfused, the procedure described here may be feasible to reduce clinically relevant side effects, i.e. hyperkalaemia and microvascular obstruction secondary to free cell fragments. This approach could be especially useful in patients undergoing massive transfusion and/or suffering from renal failure.     

180 ml and less: cardiopulmonary bypass techniques to minimize hemodilution for neonates and small infants

OBJECTIVE: To determine the efficacy of decreasing cardiopulmonary bypass (CPB) prime volume for neonates and small infants by using low prime oxygenators, small diameter polyvinyl chloride (PVC) tubing and removing the arterial line filter (ALF) in an effort to reduce intraoperative exposure to multiple units of packed red blood cells (PRBC). METHODS: Two retrospective database studies comparing neonatal CPB prime volume were undertaken: Study 1--A CPB circuit consisting of a 1/8 inch arterial line, a 3/16 inch venous line and a low prime oxygenator with 172 ml total circuit prime (n=74) was compared to a circuit with a 3/16 inch arterial line, a 1/4 inch venous line and a higher prime oxygenator with a 350 ml total circuit prime (n=74). Study 2--The 172 ml circuit (n=389) was compared to a circuit that included an ALF and had a total circuit prime volume of 218 ml (n=389). RESULTS: Study 1--of the 74 neonates and small infants whose CPB prime volume was 350 ml, 19 were exposed to two or more intraoperative exogenous PRBC units while only 3 neonates and small infants in the 172 ml prime group (n=74) received two or more units (p = 0.0002). Study 2--of the 389 neonates and small infants where an ALF was used (prime volume 218 ml), 54 were exposed to two or more exogenous PRBC units while only 36 of the 389 patients where an ALF was not used (prime volume 172 ml) received two or more units of intraoperative PRBCs (p = 0.0436). CONCLUSION: Decreasing the neonatal and small infant extracorporeal circuit prime volume by as little as 46 ml resulted in significantly fewer multiple exposures to exogenous PRBC units.     

Safety and efficacy of AS-1 red blood cell use in neonates.

Many Regional Blood Centers are providing AS-1(Adsol preservative) red blood cells (RBCs) as a standard product because of the extended shelf life (42 days). The use of AS-1 RBCs is concerning in neonates because of high exposure to dextrose, adenine and mannitol. We conducted this study to evaluate the safety and efficacy of AS-1 RBC use in neonates. We assigned one unit of AS-1 RBCs to each infant for small volume transfusions (15 ml/kg) for the life of the unit (42 days). The study was conducted for one year. The infants under 1500 g were included in the study. We measured the pre- and post-transfusion hematocrit, post-transfusion serum sodium, potassium, glucose, bilirubin and blood pH. We compared the average number of transfusions per patient and average blood donor exposure per patient using AS-1 RBC to CPDA-1 packed red blood cells (PRBC) use, data available for prior year. We monitored the blood transfusion reactions during the study period. The hematocrit increased significantly from 30.1 +/- 4.6 pre-transfusion to 38.3 +/- 4.9 post-transfusion. The post-transfusion serum bilirubin, blood pH, serum potassium, sodium and glucose remained within the normal range. In spite of an increase in the number of average transfusions per patient with AS-1 RBC (6.67 +/- 5.1), the average donor exposure (1.8 +/- 1.1) remained less than two donors. There were not any transfusion reactions reported during the study. In conclusion, the use of AS-1 red blood cells is safe for small volume transfusions in neonates.     

A comparison of resuscitation with packed red blood cells and whole blood following hemorrhagic shock in canines

Resuscitation with crystalloid and packed red blood cells has for the most part replaced the use of plasma and whole blood in the initial treatment of hemorrhagic shock. The effects of such changes on cardiovascular function following hemorrhagic shock remain largely unexplored. We examined cardiovascular function in anesthetized canines subjected to severe hemorrhagic shock. Mongrel canines of either gender were anesthetized with isoflurane and instrumented for measurement of arterial pressure, cardiac output, coronary flow, and left ventricular pressure and volume for the determination of end systolic elastance (Ees). Following a 30-min stabilization period, blood was rapidly removed to induce fixed pressure (mean arterial pressure = 35 mmHg) hemorrhagic shock for 90 min or until an arterial lactate of 7.0 mM was achieved. Animals were then resuscitated with 2/3 of the shed volume as lactated Ringer's and an equal volume of either whole blood (WB, n = 8) or packed red blood cells (PRBC, n = 10) resuspended in lactated Ringer's (LR) solution to replace expressed plasma volume. PRBC resuscitated dogs showed lower values of mean arterial pressure, cardiac output, rates of ventricular contraction and relaxation and myocardial work. Increasing the maintenance infusion rate of LR (10 mL/kg/h) following PRBC infusion normalized mean arterial pressure, but not other indices of cardiovascular function. Thus, WB, but not PRBC resuscitation restores normal myocardial function during resuscitation from severe hemorrhagic shock.     

Hyperkalemia of the blood-primed ECLS circuit does not result in post-initiation hyperkalemia in infants < 10 kg

OBJECTIVE: To assess the risk of hyperkalemia with blood-primed extracorporeal life support (ECLS) circuits in infants < 10 kg. DESIGN: Retrospective cohort study of all neonatal and pediatric patients < 10 kg placed on ECLS from May 1998 to April 2001. MEASUREMENTS AND MAIN RESULTS: Data collection including patient weight, patient potassium levels pre- and post-initiation of ECLS, potassium level of the primed ECLS circuit, age of the packed red blood cell (PRBC) unit, type of preservative, and preservative reduction status. Seventy-six circuits were available for the analysis. The age of the PRBC unit and preservative reduction status significantly affected the potassium level of the primed ECLS circuit. Multivariate linear regression analysis showed no significant effect on the post-ECLS initiation patient potassium level with respect to the PRBC age, the preservative reduction status, the patient potassium level prior to ECLS initiation, and the potassium level of the primed ECLS circuit. CONCLUSIONS: Initiation of ECLS in infants < 10 kg should not be delayed unnecessarily to perform preservative reduction or to utilize PRBC units of a specific age, as hyperkalemia of the primed ECLS circuit is not associated with systemic hyperkalemia in the patient post-initiation of ECLS.     

Blood salvage with a continuous autotransfusion system compared with a haemofiltration system

BACKGROUND: Red blood cells may be destroyed by autotransfusion processing during intraoperative salvage. The aim of the present study was to evaluate the blood component recovery rate of techniques built on either continuous centrifugation and washing, or haemofiltration (HF). METHODS: Two different methods used in blood salvage - red cell salvage with continuous processing with centrifugation and saline washing (Continuous Auto Transfusion System, CATS) and whole blood recirculation through a 30000-Da filter, i.e., HF - were compared in a randomized laboratory study using donor whole blood activated by cobra venom factor. The recovery of red blood cells, haemoglobin, free haemoglobin, leucocytes, platelets, albumin, total protein and potassium was measured. RESULTS: The recovery of red cells was 86% with CATS and 76% with HF. HF had a significantly higher recovery of leucocytes (CATS 20%, HF 63%), platelets (CATS 4%, HF 37%), albumin (CATS 0.2%, HF 70%), total protein (CATS 1.3%, HF 71%) and potassium (CATS 2%, HF 17%). Less than 1% haemolysis was obtained in processed blood from both groups. CONCLUSION: Both methods caused little destruction of the red blood cells during processing. There was a larger reinfusion of leucocytes, platelets, albumin, total protein and extracellular potassium when HF was used compared with the 'CATS' method.     

不同药物组合控制性降压在全髋置换术中的临床应用

目的评价不同降压药物组合控制性降压用于全髋置换术的临床效果。方法 60例全髋置换术患者分为3组,Ⅰ组为硝普钠组,Ⅱ组为硝普钠＋地尔硫卓组,Ⅲ组为硝普钠＋拉贝洛尔组。切皮前开始行控制性降压。持续监测并记录降压期间的平均动脉压（MAP）,心率（HR）。在降压前（T1）、降压后10 min（T2）、20 min（T3）,以及停降压后20 min（T4）4个时点分别采集动静脉血检测血糖（BG）和乳酸（LA）。计算收缩压心率乘积（RPP）、动-静脉血糖差[D（v-a）BG]、葡萄糖摄取率（BGER）和动-静脉乳酸差[L（v-a）]、乳酸生成率（LPR）。结果Ⅱ、Ⅲ组控制性降压期间硝普钠用量较Ⅰ组明显减少（P〈0.05）;降压期间Ⅰ组HR增快（P〈0.05）,而Ⅱ、Ⅲ组HR无明显变化（P〉0.05）;停止降压后,Ⅰ组MAP、RPP较降压前显著升高（P〈0.05）,Ⅱ、Ⅲ组MAP、RPP较降压前无明显变化（P〉0.05）。三组降压后各时点的动静脉血糖、乳酸与T1相比均升高（P〈0.05）;I组降压后各时点的D（v-a）BG和BGER与降压前相比有所下降（P〈0.05）,而Ⅱ、Ⅲ组D（v-a）BG和BGER各时点相比较,差异无统计学意义（P〉0.05）。Ⅰ组L（v-a）在降压后明显升高（P〈0.05或P〈0.01）,而Ⅱ、Ⅲ组变化无统计学意义（P〉0.05）,Ⅰ组LPR降压后升高（P〈0.05或0.01）,而Ⅱ、Ⅲ组明显降低（P〈0.01）。结论硝普钠联合应用地尔硫卓或拉贝洛尔是较为理想的控制性降压技术,其对机体代谢影响小,药物副反应少。