盐酸乌拉地尔对腹腔镜手术患者血流动力学的影响

目的:研究乌拉地尔对腹腔镜手术血流动力学的影响。方法:55例择期行腹腔镜胆囊切除术的患者,美国麻醉医师协会(ASA)Ⅰ～Ⅱ级。随机分为观察组(Ⅰ组,23例)和对照组(Ⅱ组,22例)。当CO2气腹后血压升高时,Ⅰ组采用乌拉地尔治疗,Ⅱ组根据血压变化调节丙泊酚和瑞芬太尼用量。记录麻醉前(T0)、气腹前(T1)、气腹后即刻(T2)、给乌拉地尔后5 min(T3)、15 min(T4)、30 min(T5)、拔管时(T6)的收缩压(SBP)、舒张压(DBP)和心率(HR);记录术中丙泊酚用量、患者苏醒期呼吸恢复睁眼时间和拔管时间,术后Ramesay镇静评分。结果:Ⅰ组经乌拉地尔治疗,术中维持血压正常平稳状态;Ⅱ组通过加深麻醉获得相似的降压效果,但HR在T3～T5时慢于Ⅰ组(P<0.05),拔管时SBP,DBP和HR高于Ⅰ组(P<0.05)。Ⅰ组术后呼吸恢复睁眼时间和拔管时间、Ramesay评分均小于Ⅱ组(P<0.05),丙泊酚用量Ⅰ组明显少于Ⅱ组(P<0.01)。结论:乌拉地尔能有效治疗CO2气腹高血压,减少丙泊酚用量,缩短清醒时间和拔管时间,并能有效抑制拔管期的心血管反应。

The impact of urapidil on pneumoperitoneum hemodynamic

Objective:To reserch the effects of urapidil in pneumoperitoneum hemodynamic.Methods:Fifty-five case laparoscopic cholecystectomy,American Society of anesthesiologists(ASA)Ⅰ～Ⅱ.Randomly divided into the observation group(groupⅠ,n=23)and the control group(groupⅡ,n=22).When blood pressure is rising after the CO2 pneumoperitoneum,groupⅠuse urapidil in the treatment.Group Ⅱ,according to blood pressure to adjust the dosage of propofol and remifentanil.To record the time of before anesthesia(T0),before pneumoperitoneum(T1),the short period after pneumoperitoneum(T2),5 min after thetreatment(T3),15 min(T4),30 min(T5),extubation(T6),systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR).Recording the dosage of propofol in the operation,the time of breathing restore and opening eyes and the time of extubation in the revival period,the sedation score of Ramesay after the operation.Results:The groupⅠused urapidil maintain the steady state of normal blood pressure.Group Ⅱ received similar antihypertensive effect by deepening anesthesia.But the HR in the T3～T5 slower than groupⅠ(P<0.05);T6,SBP,DBP and HR higher than groupⅠ(P<0.05).The time of breathing restore,the time of opening eyes,the time of extubation in the revival period and Ramesay score in group Ⅰare all less than groupⅡ(P< 0.05).The dosage of propofol in groupⅠwere less than group Ⅱ(P<0.01).Conclusion:Urapidil can effectively treat the hypertension disease caused by CO2 pneumoperitoneum,decrease the dosage of propofol,shorten the time of recovery and extubation.It can suppress the cardiovascular response during tracheal extubation.