两种尼卡地平使用方法在脊椎肿瘤手术中降压效果的比较

目的：观察和比较尼卡地平两种不同给药方法在脊椎肿瘤手术中控制性降压的效能、血流动力学改变和安全性。方法：选择24例择期手术的脊椎肿瘤患，随机分为2组，每组12例。Ⅰ组为持续输液组，在手术一 后，以10μg.kg^-1.min^-1的速率滴注尼卡地平，血压降至目标值）平均动脉压：7．33－8．66kPa)后，减量至1μg.kg^-1.min^-1滴注维持；Ⅱ组为首次负荷量＋静滴维持组，在手术开始10min后，经中心静脉通路推注首次负荷量尼卡地平0．01－0．02mg/kg，继以1－2μg.kg^-1.min^-1滴注维持。结果：两组控制性降压期间，心脏指数（CI）明显上升，其他循环指标稳定，均无停药后高血压反跳。Ⅱ组较Ⅰ组血压降至目标值时间明显缩短（P＜0．05），而且血压降至目标值所需的尼卡地平滴注剂量明显减少（P＜0．05），停药后血压恢复至降压前水平所需时间、平均出血量、平均输血输液量在两组间均无显差异（P＞0．05）。大出血期间及术后未发现严重心律失常及少尿。结论：尼卡地平控制性降压平稳，可控性强，停药后血压上升缓慢，无反跳现象，且具有心、肾保护功能，以首次负荷量加静滴维持的方法，可取得更为理想的临床效果。

Comparing controlled hypotension effects of nicardipine used in two different ways in spinal tumoroperation

Objective: To observe the controlled hypotension effects of nicardipine in 2 different ways for spinal tumor operalion. Methods: Twenty-four adult patients, scheduled for selective spinal tumor operation, were randomly divided into 2 groups. In groupⅠ(n=12), the nicardipine was infused at a rate of 10 μg*kg-1*min-1 and the infusion continued until MAP was at the level of 7.33-8.66 kPa, and then the rate was decreased to 1 μg*kg-1*min-1. In Group Ⅱ(n=12), nicardipine was given 0.01-0.02 mg/kg as the load dose, then infused at 1-2 μg*kg-1*min-1. Results: During the period of controlled hypotension, cardiac index(CI) increased significantly, other hemodynamic variables were stable and no hypertension rebound occurred in both groups. Reaching time of target blood pressure in groupⅡ was shorter than that in groupⅠ（P＜0.05）. The dose required to obtain target blood pressure in group Ⅱwas less than that in group Ⅰ（P＜0.05）. BP recovery time from discontinuing nicardipine infusion to pre-hypotension level,bleeding volume and transfusion volume were similar between 2 groups（P＞0.05）.During mass bleeding,　serious arrhythmia and oliguria did not occur in any case. Conclusion: Controlled hypotension with nicardipine is rapid, stable and easily controlled without hypertension rebound. Nicardipine has considerable protective effects on heart and kidney during mass bleeding. The method of bolus injection followed with intravenous infusion is more suitable to clinical application.