艾司洛尔复合硝普钠控制性降压用于关节镜下肩袖修补术的临床观察

目的研究艾司洛尔复合硝普钠控制性降压用于半坐卧位肩关节镜下肩袖修补的可行性及安全性。方法 2010年7月～2011年5月,选择50例单侧肩袖撕裂行关节镜手术患者,按病例单双号分为2组,每组25例。S组（单纯硝普钠组）用微量泵以0.5～5.0μg/（kg.min）速率输注硝普钠,ES组（艾司洛尔＋硝普钠组）在泵注硝普钠的同时泵注艾司洛尔150～300μg/（kg.min）。2组平均动脉压均缓慢降至55～65 mm Hg。监测降压前,降压后5 min、15 min、45 min,停药后5min、10 min的平均动脉压（MAP）、心率（HR）、心电图（ECG）、脉搏血氧饱和度（SpO2）、呼气末CO2分压（PETCO2）及颈内静脉球部血氧含量（SjvO2）,记录关节冲洗液量、尿量、硝普钠用量、手术时间、术中术野质量评分等指标。结果 2组降压后HR差异有显著性（P〈0.01）,S组伴HR升高,而ES组在降低MAP的同时可减慢HR。停药后,S组反跳性引起HR、MAP增高,ES组停药反跳不明显,2组间差异有显著性（P〈0.01）。2组降压后SjvO2有轻微下降,但均在正常范围内,差异无显著性（P〉0.05）。ES组关节冲洗液量、硝普钠用量及手术时间少于S组,术野评分优于S组,差异有显著性（P〈0.01）。结论硝普钠-艾司洛尔联合应用可使控制性降压前后的机体生理变化更趋于平稳,减少硝普钠用量,使术野更清晰,缩短手术时间,减少关节冲洗液量,脑氧代谢良好。

Clinical Investigation of Sodium Nitroprusside Combined with Esmolol in Controlled Hypotension for Arthroscopic-assisted Rotator Cuff Repair

Objective To investigate the effect of sodium nitroprusside combined with esmolol in controlled hypotension on arthroscopic-assisted rotator cuff repair.Methods Fifty patients scheduled for arthroscopic-assisted rotator cuff repair were divided into two groups according to odd/even case numbers.Group S received sodium nitroprusside 0.5-5.0 μg/（kg·min）,group ES received sodium nitroprusside 0.5-5.0 μg/（kg·min） combined with esmolol 150-300 μg/（kg·min）.In both the groups,the mean arterial pressure（MAP） decreased to 55-65 mm Hg gradually.MAP,HR,ECG,SpO2,PETCO2,and SjvO2 were determined before controlled hypotension,and 5,15,and 45 min afterwards.The volume of joint rinses,urine amount,dose of sodium nitroprusside,operation time,and the surgical field score were recorded as well.Results After hypotension,group S showed increased HR,while group ES had the HR decreased with the MAP going down（P0.05）.When the medication was stopped,group S had the HR and MAP jumped up,while in group ES,no significant bouncing up was noticed（P0.01）.No significant difference was found in the change of SjvO2 between the two groups（both slightly decreased,P0.05）.Group S showed significantly more joint rises volume,higher dose of sodium nitroprusside,and higher surgical field score（P0.01）.Conclusions Esmolol combined with nitroprusside can control the physiological change in hypotension anesthesia,with less dose of sodium nitroprusside,which makes the surgical field clearer,operation time shorter,volume of joint rinses less,and cerebral oxygen metabolism steady.