两种控制性降压药物配伍对心输出量的影响.doc

两种控制性降压药物配伍对心输出量的影响 摘 要 目的:观察硝酸甘油联合艾司洛尔和硝普钠联合艾司洛尔控制性降压期间心输出量的变化，从而进一步探讨该技术的安全性。 方法 32例ASAⅠ~Ⅱ级，拟行鼻内镜手术患者，男20例，女12例，年龄22～60岁，随机分为两组：N组，术中使用硝酸甘油联合盐酸艾司洛尔控制性降压；S组，术中使用硝普钠联合盐酸艾司洛尔（S组）控制性降压；每组16例。分别于麻醉诱导前（T0）、降压后30min（T1）、降压后60min（T2）观察并记录各组患者每搏输出量（SV）及心输出量（CO）的变化数值。结果 两组患者年龄、体重等一般情况无显著差异。N组：T1、T2时CO、SV均较T0时显著下降（P<0.05）；S组T1、T2时CO、SV亦较T0时显著下降（P<0.05）；两组之间比较：T0时两组心率（HR）、平均动脉压（MAP）、SV、CO均无显著差异；T1、T2时N组SV明显低于S组相应时点SV（P<0.05）；T1、T2时N组CO亦明显低于S组相应时点CO（P<0.05）。结论 硝酸甘油联合艾司洛尔及硝普钠联合艾司洛尔均能达到良好的控制降压效果；两种药物配伍均能使心输出量降低；硝酸甘油联合艾司洛尔降压期间对心输出量的影响较硝普钠联合艾司洛尔的影响大，差异具有统计学意义。 关键词 控制性降压，血流动力学，心输出量，每搏输出量 Effect of two drug combination methods on the cardiac outputduring controlled hypotension Abstract Objective: This study is to observe and compare the effect on cardiac output during controlled hypotension by esmolol associated with nitroglycerin (NTG) or sodium nitroprusside(SNP), by this way to discuss the safety of this method furtherly. Methods : Thirty-two ASAⅠor Ⅱpatients aged 20-66, 20 males and 12 females, undergoing functional endoscopic sinus surgery were randomly assigned to 2 groups（n= 16each）: group N and group S. Group N was esmolol complex NTG, and group S was esmolol complex SNP. The changes of strock volume(SV) and cardiac output(CO) were monitored at T0 (at the moment just before anesthetizing)、 T1 (30 minutes after controlled hypotension ) and T2 (60 minutes after controlled hypotension) and recorded them. Results: The age, weight had no significant deviation in the two groups. In group N, there was a significant reduction in SV and CO at T1 and T2 compared with T0（P<0.05）, there was a same change in group S. SV and CO significantly decreased at T1 and T2 in group N compared with that in group S（P<0.05） Conclusion: These two drug combination methods for controlled hypotension ——compound of esmolol and NTG or SNP, are able to achieve satisfied effect of controlled hypotension and decrease the cardiac output. The combinatioin of NTG and esmolol cause more significant redu