硝普钠复合美托洛尔控制性降压用于鼻窦内窥镜手术的研究

目的观察硝普钠复合美托洛尔控制性降压用于功能性鼻窦内窥镜手术（FESS）对血流动力学的影响和降压效果。方法60例ASAⅠ～Ⅱ级择期行FESS患者，随机分为硝普钠复合美托洛尔组（MP组，n=30）和硝普钠组（P组,n=30）。分别记录2组患者降压前（T0）、降压开始后15min即刻（T1）、降压开始后30min即刻（T2）和停降压后15min即刻（T3）各时间点的心率（HR）、平均动脉压（MAP）和心率收缩压乘积（RPP）的变化以及硝普钠的用药总量。结果P组在T1、T2和T3时的HR与T0相比明显增快（P〈0．01），而MP组各时间点的HR与T0相比则无显著差异；2组T1、T2和T3时的HR相比有非常显著的差异（P〈0．01）。2组患者T1和T2时的MAP与T0相比均显著降低；而P组患者T3与T0的MAP相比有强著增高；MP组患者T3与T0的MAP相比则无显著差异。MP组T1、T2和T3时的RPP比T0时显著降低，且与P组各相应时间点相比有显著差异（P〈0．01）。MP组硝普钠的总用量显著少于P组（P〈0．01）。结论硝普钠复合美托洛尔控制性降压应用于FESS可产生协同作用，维持术中血流动力学稳定，降压效果确切，而且无明显的心率增快，血压回升反跳等不良反应。

Effect of Hypotension Induced by Metoprolol and Sodium Nitroprusside during Functional Endoscopic Sinus Surgery

Objective To observe the effects of hypotension induced by metoprolol and sodium nitroprusside on hemodynamics in patient during functional endoscopic sinus surgery. Methods Sixty ASA Ⅰ～Ⅱ patients scheduled for functional endoscopic sinus surgery were randomly allocated to one of two groups： metoprolol and sodium nitroprusside-induced hypotension group （group MP,n=30） and sodium nitroprusside-induced hypotension group （group P,n=30）. Mean arterial pressure （MAP）, heart rate （HR） and rate-pressure product （RPP） were monitored before induced hypotension（T0 ）, 15 rain（T1 ） .30 min（T2 ） following induced hypotension and 15 min after induced hypotension（T3）. The dosage of sodium nitroprusside was determined. Results In group P HR increased significantly at T1、T2 and T3 （P〈0.01） whereas there was no significant change in HR in group MP. There was significant difference in HR at T1 、T2 and T3 between the two groups （P〈0.01）. MAP at T3 was higher than that at T0 in group P（P〈0.01）. RPP levels were lower at T1、T2 and Ta than the baseline values in group P and those in group MP（P〈 0.01）. The dosage of sodium nitroprusside was lower in group MP than that in group P（P〈 0.01）. Conclusion In functional endoscopic sinus surgery sodium metoprolol and sodium nitroprusside-induced hypotension could provide synergism without rebounding phenomenon, and hemodynamics can be fairly well maintained.