尼卡地平对高血压患者围术期心肌保护作用.docVIP

尼卡地平对高血压患者围术期心肌保护作用 　 作者：曹君瑜 叶球军 樊理华 曾伟珍 【摘要】 目的 研究尼卡地平对高血压患者围术期降压效果及其对心肌的保护作用。 方法 40例择期行上腹部手术高血压患者随机分为尼卡地平组(N组)和对照组(C组)，C组仅接受麻醉药;N组诱导前3min静注尼卡地平10～20μg/kg-1,随后持续静脉泵注0.5～1.5μg／（kg·min）, 观察给药前后患者心率、血压及心率收缩压乘积的变化, 并于手术前、后1h分别采血用单克隆抗体酶联免疫法检测血清cTnI浓度。结果 N组cTnI浓度术后无明显增加(Pgt;0.05), C组则明显高于术前(Plt;0.01); 两组间差异有显著性(Plt;0.01), 且N组有效抑制了气管插管时的心血管反应, 与C组比差异有显著性(Plt;0.01)。 结论 尼卡地平不但有效抑制气管插管所致的心血管反应, 并能预防和减少围术期心肌损伤的发生。 【关键词】 尼卡地平 心肌损伤 高血压患者 　　【Abstract】 Objective To determine the value of using Nicardipine to prevent and treat myocardial ischemia in hypertensive patients. Methods Forty patients undergoing abdominal surgery were randomly divided into two groups treated with Nicardipine (N group , 20 patients) or without Nicardipine (C group , 20 patients) . The N-group administered 10-20ug/kg of Nicardipine iv 3 min before induction and Nicardipine 0.5-1.5ug/kg-1/min-1 also infused during operation. The C-group used 0.9% NS as substitute. The blood pressure and heart rate(HR) were recorded , and rate-pressure product (RPP) was counted. Blood from peripheral vein was withdrawn at three points(before operation, after operation and 24h after operation) for cardic troponin I(cTn I) marker. Results The CTnI marker didn’t increase significantly after operation(Pgt;0.05) .Serum the CTnI marker elevated significantly in C-group than in preoperation (Plt;0.01) . There were significant differed between the two groups(Plt;0.01), and in N group, cardiovascular effects was effectively inhibited from intubation controlling, compare with C ,the difference was significant(Plt;0.01). Conclusion Nicardipine not only effectively helps to control cardiac vascular reaction during intubation, it also reduces and prevents the onset of perioperative myocardial damage in hypertensive patients. 　　【Key words】 Nicardipine myocardial ischemia hypertensive patients 手术创伤可导致明显的应激反应, 引起机体代谢和内环境紊乱。高血压患者因其本身的病理生理改变, 围术期意外事件发生率远高于正常人。本组采用单克隆抗体酶联免疫法观察手术前后心肌肌钙蛋白 I(cTnI)浓度及血流动力学变化, 作者就手术和麻醉应激对高血压患者心肌损伤的影响及尼卡地平的干预效果进行