乌拉地尔和小剂量艾司洛尔联合应用对术后气管拔管心血管反应的影响

时间: 2017-10-22 21:00:11 来源:未知 作者:admin 点击:42 次
  

                     作者:李 扬,熊利泽,陈绍洋,王庆德,雷 霆,杨 琨,向 宁 

【关键词】  拔管反应
    关键词: 拔管反应;乌拉地尔;艾司洛尔;脑外科学 
    摘 要:目的  观察小剂量乌拉地尔和艾司洛尔联合应用对颅脑手术后气管拔管的心血管反应的影响. 方法  37例行开颅手术患者随机分为4组:A组(n=10,乌拉地尔0.4mg・kg-1 );B组(n=8,艾司洛尔0.5mg・kg-1 );C组(n=9,乌拉地尔0.2mg・kg-1 +艾司洛尔0.25mg・kg-1 );D组(n=10,生理盐水2mL).分别于拔管前2min静注.记录术前、给药前、给药后、拔管即刻、拔管后1,3和5min,回NICU后的SBP,DBP,MAP及HR. 结果  D组:血压、心率在拔管即刻均较术前升高(P<0.05).A组:拔管后1,3和5min的血压均低于术前(P<0.05),心率在拔管即刻及拔管后明显较术前增快(P<0.05).C组:拔管后SBP明显低于给药前,DBP,MAP及HR无明显变化.拔管即刻:A组HR明显高于B组和C组(P<0.05),A组和D组的HR无差异(P>0.05),B组拔管即刻DBP和MAP高于A组(P<0.05),C组拔管即刻SBP低于B组和A组(P<0.05).在NICU:B组心率高于A组(P<0.05). 结论  小剂量乌拉地尔与艾司洛尔联合应用可预防围拔管期血压升高,并能弥补拔管时单独应用乌拉地尔不能有效控制心率的不足,预防颅脑手术全麻后气管拔管时心血管反应.
      
  Keywords:extubation;urapidil;esmolol;brain surgery
     
    Abstract:AIM To observe the effect of urapidil combined with a small-dose esmolol on cardiovascular responses to tra-cheal extubation following intracranial surgery.METHODS 37patients undergoing intracranial surgery were included in a randomized study consisting of4groups:Group D receiv-ing normal saline as the control,while Groups A,B Group C receiving urapidil0.4mg・kg-1 ,esmolol0.5mg・kg-1 and urapidil0.2mg・kg-1 +esmolol0.25mg・kg-1 ,respective-ly.Extubation was performed2min after the designated drug was intravenously administered.SBP,DBP,MAP and HR were observed at pre-operation,pre-administration,after ad-ministration,at extubation and1,3,5min after extubation and in NICU.RESULTS BP and HR at extubation were sig-nificantly higher than pre-operation values in Group D(P<0.05).BPs1,3,5min after extubation was significantly lower than those of pre-operation and HR was significantly faster than that of pre-operation in Group A(P<0.05).SBP after extubation was significantly lower than that of pre-ad-ministration and DBP,MAP,HR showed no change in Group C.SBP at extubation in Group C was significantly lower than those of Group B(P<0.05)and Group A(P<0.05)respectively.CONCLUSION Urapidil combined with a small-dose esmolol attenuates the cardiovascular responses to tracheal extubation following intracranial surgery.
     
  0 引言
     
  全麻后气管拔管可发生与气管插管类似的心血管反应[1] ,颅脑手术麻醉时的拔管反应可致术野出血,颅内压增高,并加重脑水肿.乌拉地尔和艾司洛尔分别系中枢及外周双重作用的降压药和超短效β-受体阻滞药,在临床中已广泛用于预防全麻气管插管及拔管反应,但单纯使用一种药物并不能完全预防气管拔管所致心血管副反应,且有一定副作用.本研究观察两种药物联合应用对颅脑手术围拨管期的影响.
     
  1 对象和方法
     
  1.1 对象  择期开颅手术患者37例,ASA I~II级,无心、肺疾患及特殊用药史.
     
  1.2 方法  ①麻醉:入室前东莨菪碱0.3mg肌肉注射.全麻诱导,静脉注射硫贲妥钠4~5mg・kg-1 ,咪唑安定0.02~0.04mg・kg-1 ,芬太尼4~5μg・kg-1 ,维库溴铵0.1mg・kg-1 ,行气管内插管,呼吸机行控制呼吸,维持PET CO2 4.5~5.0kPa.异丙酚3~6mg・kg-1 ・h-1 微量泵输注维持麻醉,间断静注芬太尼及维库溴铵.术毕拔管指征:清醒,呼之睁眼,自主呼吸及吞咽反射恢复,PET CO2 <6.0kPa(45mmHg),呼吸空气5min SpO2 >95%.②监测:患者随机分为4组,分别于术毕拔除气管导管前静注.A组(n=10):乌拉地尔0.4mg・kg-1 (西安利君制药股份公司,批号:010728);B组(n=8):艾司洛尔0.5mg・kg-1 (齐鲁制药厂,批号:0102001);C组(n=9):乌拉地尔0.2mg・kg-1 +艾司洛尔0.25mg・kg-1 ;D组(n=10):生理盐水2mL对照.用药后2min拔除气管导管.所有患者术中持续监测心电图、SpO2 ,PET CO2 ,无创血压(Agilent M1205A监护仪,美国).记录术前、给药前、给药后、拔管即刻、拔管后1,3和5min和回NICU后的血压和心率.统计学处理:各实验数据以x ±s表示,用SPSS统计软件分别行组内及组间单因素方差分析.
     
  2 结果
     
  2.1 一般情况  4组患者年龄、性别、体质量、手术时间分别为:A组,(46.2±9.1)岁,4/6(M/F),(61.6±8.0)kg,(173.0±49.2)min;B组,(40.0±14.8)岁,5/3(M/F),(60.6±10.2)kg,(169.8±51.0)min;C组,(40.0±14.8)岁,4/5(M/F),(60.0±5.6)kg,(170.9±53.1)min;D组,(44.0±17.3)岁,6/4(M/F),(63.0±9.7)kg,(170.0±50.1)min,均无统计学差异,观察期间未出现心律失常. 
  2.2 心血管反应  D组:SBP,DBP,MAP及HR拔管即刻均较术前及给药前明显增高(P<0.05).A组:拔管即刻SBP,DBP和MAP与术前无差异,拔管后1,3和5min血压明显低于术前(P<0.05),HR在拔管即刻、拔管后1,3和5min均较术前及给药前明显增快(P<0.05).B组:拔管后血压、心率无明显变化.C组:拔管即刻、拔管后1,3和5min的SBP明显低于给药前(P<0.05),DBP,MAP及HR无明显变化(Fig1,2).

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