艾司洛尔复合硝酸甘油控制性降压在高血压患者脊柱手术中的临床应用

目的：探讨艾司洛尔复合硝酸甘油控制性降压在高血压患者脊柱手术中的临床应用。方法：60例高血压患者随机分为两组：I组（单纯硝酸甘油组）、Ⅱ组（艾司洛尔复合硝酸甘油组）,每组各30例。I组持续输注硝酸甘油,起始速率2.5μg/（kg.min）;Ⅱ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）。调整药物输注速率（调整梯度：以硝酸甘油增加或减少0.5μg/（kg.min）为准）使平均动脉血压（MAP）维持在基础血压的80%（目标血压）左右至手术结束。记录开始降压前即刻（T0）、降压30 min（T1）6、0 min（T2）、停止降压后15 min（T3）4个时间点血压（SBP、DBP、MAP）、心率（HR）、中心静脉压（CVP）的变化及晶胶体输入量、尿量、出血量和输血量。同时记录两组患者血压降至目标血压所需的时间,停药后血压开始回升所需的时间。结果：两组患者MAP的下降均显著低于降压前（P〈0.01）,降压期间Ⅱ组的心率显著低于Ⅰ组（P〈0.05）。两组术中出血量、尿量、输血量无显著差异（P〉0.05）。两组患者开始降压时间分别为（5.6±2.0）min和（2.8±1.3）min,Ⅱ组短于Ⅰ组（P〈0.05）。停药后Ⅱ组血压回升时间较Ⅰ组明显缩短（P〈0.05）。结论：硝酸甘油复合艾司洛尔控制性降压应用于高血压患者脊柱手术安全、有效,可控性好,能缩短手术时间,并且可防止反射性心率增快。

Evaluating Effect of Esmolol Combined with Nitroglycerin During Induced Hypotension on Hypertension Patients in Spinal Surgery

Objective：To evaluating the effect of esmolol combined with nitroglycerin during induced hypotension on hypertension patients in spinal surgery.Methods： 60 patients were randomly divided into two groups：group I（n=30）was simple nitroglycerin;groupⅡ（n=30） was esmolol combined with nitroglycerin.Group I initially received nitroglycerin at 2.5 μg/（kg·min）-1and group Ⅱ initially received nitroglycerin2.5 μg/（kg·min）-1and esmolol12.5 μg/（kg·min）-1.The nitroglycerin dosage was adjusted to maintain the MAP level at target in two groups.Hemodynamic parameters were recorded before controlled hypotension,just at the moment of controlled hypotension（T0）、30 min after controlled hypotension（T1）、60 min after controlled hypotension（T2）、15 min after controlled hypotension（T3）.Also the operating time、intra-operative blood loss、blood transfusion amounts and urine were recorded.Results：The MAP level of two groups were all significantly decreased during controlled hypotension（P0.01）.HR change of groupⅡ in T0,T1,T2 was lower than group Ⅰ（P0.05）.There were no deficiency in the intra-operative blood loss 、 blood transfusion and urine between both groups（P0.05）,The duration of operation was significant shorter in group Ⅱ than in group Ⅰ、and the duration of recovering was shorter in group Ⅱ（P0.05）.Conclusions：Nitroglycerin combined with esmolol can decrease the intra-operative blood loss and blood transfusion amounts,prevent the reflex enhancement of HR and reduce the duration of operation.So it is safe and effect for controlled hypotension on hypertension patients in spinal surgery.