髋关节置换术患者靶控输注异丙酚复合麻醉下地尔硫卓控制性降压的效果

目的研究髋关节置换术患者靶控输注(TCI)异丙酚复合麻醉下地尔硫卓控制性降压的效果。方法择期髋关节置换术患者40例,随机分为对照组和观察组,每组20例。2组麻醉诱导相同。手术开始前观察组以5.0μg.kg-1.min-1的速度持续静脉泵注地尔硫卓,每2 min调高2.5μg.kg-1.min-1,直到平均动脉压(MAP)降至8.0 kPa,并维持MAP 7.3～8.7 kPa至手术结束。对照组不施行控制性降压。记录控制性降压开始即刻(T1)、开始后30 min(T2)、60 min(T3)和停止降压后15 min(T4)心率(HR)、MAP,并于以上各时点行动脉血气分析、胃黏膜二氧化碳分压(PgCO2)和胃黏膜的pH(pHi)测定,同时记录术中出血量和手术时间。结果与对照组相比,观察组术中出血量少、手术时间缩短(P<0.05);地尔硫卓使血压下降至目标血压所需时间为(6.5±2.5)min,地尔硫卓泵注速度为(10.2±3.3)μg.kg-1.min-1,停药后(13.5±4.1)min MAP恢复至降压前水平。与T0相比,观察组T2、T3时HR、MAP降低(P<0.05);与对照组相比,观察组T2、T3时HR、MAP降低(P<0.05)。2组各时点动脉血pH、PgCO2及pHi差异无统计学意义(P>0.05)。结论TCI异丙酚复合麻醉下髋关节置换术患者持续泵注地尔硫卓控制性降压可控性好,降压及恢复平稳。

Efficacy of controlled hypotension of diltiazem in patients undergoing hip replacement under target-controlled infusion of propofol

Objective To evaluate the efficacy of controlled hypotension of diltiazem in patients undergoing hip replacement under target-controlled infusion of propofol. Methods Forty hip replacement patients were randomly divided into control group and observation group, twenty in each group. The same anesthesia induction were taken in two groups. Continuous intravenous infusion diltiazem was started at 5.0 μg·kg^-1·min^-1 before operation and increased by 2.5 μg·kg^-1·min^-1 every 2 minute until the mean arterial pressure （MAP） down to 8.0 kPa and keeped the MAP between 7.3 - 8.7 kPa through operation in observation group. The control group was not given controlled hypotension. Heart rate （I4R） and MAP were recorded at controlled hypotension start immediately （T1 ）, after the start of 30 min （T2 ）, 60 min （T3 ） and 15 minute （T4 ） after stop decreasing blood pressure, and at the same time point, arterial blood gas was analysed, gastric intramucosal partial pressure of carbon dioxide（ PgCO2 ） and gastric intramncosal of pH（pHi） were measured,the duration of operation and intraoperative blood loss were recorded. Results The duration of operation and intraoperative blood loss were significantly more in control group than those in observation group（P 〈 0. 05）. The time of diltiazem dropped blood pressure to the target blood pressure was （6.5 ± 2. 5） min by continuous intravenous infusing of diltiazem at （ 10.2±3.3） μg·kg^-1·min^-1. MAP retuned to the levels before controlled hypotension after stop controlling hypotension （13.5± 4.1 ）min. HR and MAP at T2,T3 were significantly lower than thoes at TO in observation group （P 〈 0.05 ）. HR and MAP at T2 , T3 in observation group were significantly lower than thoes in control group（P 〈 0.05 ）. There were no statistic differences of arterial blood gas analysis results, PgCO2 and pHi between two groups （P 〉 0.05 ）. Conclusion Continuous infusion of dihiazem combined with target-controlled infusion of prop