尼卡地平联合艾司洛尔对老年高血压病患者气管导管拔管反应的影响

摘要

目的 观察尼卡地平联合艾司洛尔对全身麻醉老年高血压病患者气管导管拔管期间心血管反应的影响.方法 选择30名择期行腹部手术的老年高血压患者,完全随机分为对照组,尼卡地平组与尼卡地平+艾司洛尔组3组2各10例.对照组患者静脉注射生理盐水,尼卡地平组患者静脉注射尼卡地平10 μg/kg,尼卡地平+艾司洛尔组静脉注射尼卡地平10 μg/kg和艾司洛尔1 mg/kg,记录所有患者给药前(基础值),拔管前,拔管时,拔管后5、10 min的心率、收缩压、平均动脉压.结果 对照组患者出现明显心血管反应,拔管刺激时心率、收缩压、平均动脉压[分别为(95.8±9.3)次/min、(160.4±32.3)mm Hg(1 mm Hg=0.133 kPa)、(128.3±8.9)mm Hg]显著高于基础值(P＜0.01);尼卡地平组患者拔管前、拔管时的心率较基础值高(P＜0.05),拔管前及拔管时的收缩压、平均动脉压较基础值[分别为(123.5±19.5)mm Hg、(121.6±19.0)mm Hg、(145.3±24.3)mm Hg]低(P＜0.05);尼卡地平+艾司洛尔组拔管前及拔管时收缩压较基础值低(P＜0.01),心率较基础值低(P＜0.05),整个拔管观察期平均动脉压均低于基础值(P＜0.05).结论 尼卡地平复合艾司洛尔可以有效地控制高血压患者的气管导管拔管期心血管反应,且无明显不良反应.%Objective To observe the effect of the combined administration of nicardipine and esmolol on cardiovascular response to tracheal extubation in patients with hypertension. Methods Thirty patients were randomly divided into 3 groups: Group Ⅰ , control group; Group Ⅱ , nicardipine group; and Group Ⅲ, studied group. Before extubation, the patients were pretreated with a intravenous infusion of physiological saline in Group Ⅰ , nicardipine 10 μg/kg in Group Ⅱ, and esmolol 1 mg/kg and nicardipine 10 μg/kg in Group Ⅲ. Heart rate( HR) , mean systemic arterial pressure( MAP) of all patients were separately recorded premedication, before extubation, at extubation, 5 mins and 10 mins after extubation. Results Patients in Group Ⅰ had obvious cardiovascular response,especially at the moment of extubation. HR, SBP and MAP were greatly higher than the basic value. (P <0. 01).Before extubation, at extubation HR was higher than the basic value in Group Ⅱ (P<0.05). Before extubation, at extubation SBP was even lower than the basic value in Group Ⅲ (P < 0. 01). HR was lower than the basic value.The whole observation period extubation MAP were lower than the basic value in Group Ⅲ. Conclusion The combinative administration of nicardipine and esmolol can effectively control the cardiovascular response to extubation among the hypertensive patients and without obvious side effects.