硝酸甘油复合艾司洛尔控制性降压在腹腔镜下胆囊切除术的应用

目的探讨硝酸甘油复合艾司洛尔控制性降压在腹腔镜胆囊切除术(LC)中应用的效果。方法 66例LC患者术中MAP超过100mm Hg,随机均分为A组(硝酸甘油降压)、B组(硝酸甘油+艾司洛尔降压)和C组(不行降压)。三组均采用气管内插管全身麻醉。记录气腹前(T1)、气腹后5min(T2)、15min(T3)、30min(T4)以及解除气腹后5min(T5)MAP、HR和心率收缩压乘积(RPP)。结果 C组气腹后各时间点MAP、HR、RPP均显著高于气腹前(P<0.01);A组在降压期间各时间点的HR及RPP均较降压前明显升高(P<0.01);B组降压期的HR及RPP较降压前及A、C两组显著降低(P<0.01)。结论硝酸甘油复合艾司洛尔控制性降压较单用硝酸甘油降压更能有效降低患者心肌耗氧量、提高围术期的安全性。

Application of deliberate hypotension with nitroglycerin and esmolol in patients undergoing laparocholisystectomy

Objective To investigate the efficacy of deliberate hypotension(DH) with combined use of nitroglycerin and esmolol in patients undergoing laparocholisystectomy(LC).Methods Sixty-six LC patients under general anesthesia were equally assgined into three groups of A(DH with nitroglycerin),B(DH with nitroglycerin and esmolol) and C(without DH),who had MAP greater than 100 mm Hg during LC.MAP and HR were recorded and RPP was calculated before(T1) and at 5 min(T2),15 min(T3),30 min(T4)during pneumoperitonium and 5 min(T5) after deflation.ResultsMAP,HR and RPP in group C were significantly higher at T2,T3 and T4 than those at T1(P<0.01).HR and RPP in group A were significantly higher during DH than those at T1(P<0.01),which in group B were lower during DH than those at T1 and those in groups of A and C(P<0.01).Conclusion Compared to DH with nitroglycerin alone,combined nitroglycerin and esmolol for DH is more effective in reducing myocardial oxygen comsumption and improving perioperative safety.