两药合用控制性降压对鼻内镜手术中术野质量的改善作用

目的:比较单独应用尼卡地平和尼卡地平复合艾司洛尔控制性降压在鼻内镜术中的术野质量。方法:40例行鼻内窥镜手术患者,随机分成尼卡地平组(N组,n=20)和尼卡地平复合艾司洛尔组(NE组,n=20),两组分别用尼卡地平和尼卡地平、艾司洛控制性降压,平均动脉压控制在55mmHg～60mmHg之间,记录降压前后MAP、HR变化以及术中出血量、手术时间,对术野质量进行评分。结果:与降压前MAP比较,N组在停药后各时点明显降低(P<0.01),NE组在停药10min显著低于降压前(P<0.01),NE组在停药20min、30min与N组同期比较明显升高(P<0.01);与降压前HR比较,N组在降压期间显著增快(P<0.05),NE组在降压期间及停药10min与N组同期比较显著减慢(P<0.01);NE组术中各时间点术野质量评分及尼卡地平用量明显低于N组(P<0.01)。结论:尼卡地平复合艾司洛尔用于鼻内镜术中控制性降压可明显改善术野质量,提高手术效率,可能与控制心率有密切关系。同时有血压波动小、可控性好、停药后血压回升较快等优点,比单独应用尼卡地平效果更佳。

Improvemnt of Nicardipine Combined with Esmolol on Surgery Field During Controlled Hypotension of Anesthesia in Endoscopic Sinus Surgery

Objective The study was designed to evaluate the quality of surgery field between single nicardipine and nicardipine combined with esmolol during controlled hypotension of anesthesia in endoscopic sinus surgery(ESS).Methods Forty ASA Ⅰ-Ⅱ patients underwent ESS were randomly divided into nicardipine group(group N, n=20) and nicardipine combined with esmolol group(group NE, n=20),two group used respectively nicardipine and nicardipine、esmolol to control hypotension,MAP and heart rate(HR) were recorded after controlled hypotension,bleeding volume、nicardipine dosage,operation time, and surgical field were accessed.Results There was a significant difference in MAP between group N and group NE after discontinuing drugs infusion 20 minutes and 30 minutes(P<0.01);HR of group NE was a significant slower than those of group N during controlled hypotension and after discontinuing drugs infusion 10 minutes(P<0.01);in surgery field grade, group NE were significantly lower than group N during controlled hypotension(P<0.01).Conclusion Nicardipine combined with esmolol during controlled hypotension in endoscopic sinus surgery(ESS) can improve significantly the quality of surgery field,which could be correlate to controlled heart rate.Moreover,there are other advantages,such as blood pressure comeback fast,effectively prevent HR from increasing,et al.Effect of nicardipine combined with esmolol were better than effect of single nicardipine in controlled hypotension of anesthesia in ESS.