不同药物组合控制性降压在全髋置换术中的临床应用

摘要

Objective To investigate the clinical effect of different drug combinations for controlled hypotension in total hip replacement surgery. Methods Sixty patients undergoing total hip replacement surgery were divided into group I (sodium nitroprusside group), group Ⅱ (sodium nitroprusside + diltiazem group) and group Ⅲ (sodium nitroprusside + labetalol group). Controlled hypotension was conducted for all patients after anesthesia induction. Mean arterial pressure (MAP) and heart rate (HR) were monitored continuously. The levels of blood glucose (BG) and lactate (LA) in vein and artery were detected before controlled hypertension (T1), 10 min after hypotension (T2), 20 min after hypertension (T3) and 20 min when hypotension drugs were withdrawn. Rate pressure product (RPP), arteriovenous difference in blood glucose (D(v- a)BG), blood glucose extraction rate (BGER), arteriovenous difference in lactate (L(v- a) )and lactate produce rate (LPR) were calculated. Results The total doses of nitroprusside of group Ⅱ and group Ⅲ were significantly less than that of group I (P<0.05). The heart rate of group I was faster after controlled hypotension(P<0.05), but there were no significant differences in group Ⅱ and group Ⅲ (P>0.05). The levels of BG and LA in vein and artery after controlled hypotension in three groups were higher than before controlled hypotension (P<0. 05). D(v - a)BG and BGER decreased, whileL(v- a)increasedaftercontrolledhypotensioningroup I (P<0. 05),however,D(v- a)BG,BGER and L(v- a) of group Ⅱ and group Ⅲ had no differences after the treatment. (P>CT. 05). The level of LPR increased in group I , but decreased in group Ⅱ and group Ⅲ after controlled hypotension (P<0. 01). Conclusion Nitroprusside combined with diltiazem or labetalol is an ideal method for hypotension control, as it has little negative impact on metabolism and has fewer side effects.%目的 评价不同降压药物组合控制性降压用于全髋置换术的临床效果.方法 60例全髋置换术患者分为3组,Ⅰ组为硝普钠组,Ⅱ组为硝普钠+地尔硫卓组,Ⅲ组为硝普钠+拉贝洛尔组.切皮前开始行控制性降压.持续监测并记录降压期间的平均动脉压(MAP),心率(HR).在降压前(T1)、降压后10 min(T2)、20 min(T3),以及停降压后20 min(T4)4个时点分别采集动静脉血检测血糖(BG)和乳酸(LA).计算收缩压心率乘积(RPP)、动-静脉血糖差[D(v-a)BG]、葡萄糖摄取率(BGER)和动-静脉乳酸差[L(v-a)]、乳酸生成率(LPR).结果 Ⅱ、Ⅲ组控制性降压期间硝普钠用量较Ⅰ组明显减少(P＜0.05)；降压期间Ⅰ组HR增快(P＜0.05),而Ⅱ、Ⅲ组HR无明显变化(P＞0.05)；停止降压后,Ⅰ组MAP、RPP较降压前显著升高(P＜0.05),Ⅱ、Ⅲ组MAP、RPP较降压前无明显变化(P＞0.05).三组降压后各时点的动静脉血糖、乳酸与T1相比均升高(P＜0.05)；Ⅰ组降压后各时点的D(v- a)BG和BGER与降压前相比有所下降(P＜0.05),而Ⅱ、Ⅲ组D(v-a)BG和BGER各时点相比较,差异无统计学意义(P＞0.05).Ⅰ组L(v-a)在降压后明显升高(P＜0.05或P＜0.01),而Ⅱ、Ⅲ组变化无统计学意义(P＞0.05),Ⅰ组LPR降压后升高(P＜0.05或0.01),而Ⅱ、Ⅲ组明显降低(P＜0.01).结论 硝普钠联合应用地尔硫卓或拉贝洛尔是较为理想的控制性降压技术,其对机体代谢影响小,药物副反应少.