艾司洛尔降心率对鼻内镜术降压患者鼻血流、脑灌注、心输出量及术野的影响题库.doc

艾司洛尔降心率对鼻内镜术降压患者鼻血流、脑灌注、心输出量及术野的影响 纪存良 李天佐 首都医科大学附属北京同仁医院 【摘要】目的 评价艾司洛尔控制心率对硝酸甘油降压时人鼻粘膜血流、脑灌注、心输出量和术野的影响。方法 择期鼻内镜手术患者60例ASAI或II级，体重49~85 kg ，BMI＜30 kg/m2，性别不限，随机分为2组(n = 30): 硝酸甘油降压组(N组)和硝酸甘油降压复合艾司洛尔降心率组(E组）。静脉注射咪达唑仑、维库溴铵、异丙酚和瑞芬太尼麻醉诱导，置入可弯曲喉罩，行机械通气，吸入七氟烷复合笑气维持麻醉。N组静脉输注硝酸甘油1 ~ 3 μg ?kg‐1 ? min‐1降压，E组降压后给予艾司洛尔50 ~ 300 μg ?kg‐1 ? min‐1控制心率，术中维持BIS 40~ 60，维持MAP为基础值70%。术毕待患者清醒拔出可弯曲喉罩。分别于麻醉诱导后降压开始前(T1)、降压45min时(T2)记录MAP、HR、 SV、CO、鼻粘膜血流BF，同时采桡动脉血和颈内静脉球部血样，计算动静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2) ，术毕术者对术野行清晰度评分（Fromme评分）。结果 与N组比较，E组控制心率后CO 、BF和F值降低( p 0.05)，MAP与SV，HR与 BF及F值相关显著（p 0.05）；两组患者不同时刻Da-jvO2和CERO2差异无统计学意义（ p 0.05)。结论 硝酸甘油降压时复合艾司洛尔降低心率, 可适当减少心输出量,改善鼻粘膜出血，使术野清晰；不产生严重脏器灌注不足，用于鼻内镜手术是安全的。 【关键词】心输出量；鼻粘膜血流；术野清晰度评分；鼻内镜手术；脑灌注 Effects of heart rate decreased by esmolol on cardiac output，nasal mucosa blood flow , cerebral perfusion and surgical field during endoscopic sinus surgery under controlled hypotension Ji Cun-liang Li Tian-zuo Department of Anesthesiology，Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China Corresponding author: Li Tian-zuo , Email: trmzltz@126. com 【Abstract】 Objective To evaluate the effects of controlled heart rate by esmolol combined with induced hypotention by nitroglycerin(NTG) on cardiac output ,nasal mucosa blood flow, cerebral perfusion and surgical field in patients undergoing endoscopic sinus surgery. Methods Sixty ASA I or II patients of both sexes, weighing 49-85 kg, body mass index(BMI)30 kg/m2 undergoing endoscopic sinus surgery were randomly divided into 2 groups ( n= 30 each): NTG group (group N) and combined NTG with esmolol group(group E). Anesthesia was induced with midazolam, propofol, remifentanil and vecuronium and maintained with sevoflurane combined with N2O，FLMA was inserted and the patients were mechanically ventilated. BIS was maintained at 40-55 and MAP at 70% of the basaeline value with NTG (1-3μg ?kg‐1 ? min‐1 ) infused during operation. Esmolol (50-300μg ?kg‐1 ? min‐1) was infused