乌拉地尔和硝酸甘油对高血压患者单肺通气期间血液动力学和肺内分流的对比性研究

摘要

目的：比较乌拉地尔和硝酸甘油对高血压患者单肺通气( OLV)期间血液动力学和肺内分流的影响。方法60例择期手术拟行OLV麻醉的高血压患者,年龄45~66岁,体重50~65kg,ASAⅠ~Ⅱ级,随机均分为乌拉地尔组( U组)和硝酸甘油组(N组)。麻醉诱导后行双腔导管气管插管,侧卧位后行单肺通气,同时U组和N组分别持续静脉输注乌拉地尔4μg/(kg·min)和硝酸甘油2μg/(kg·min)。记录并比较患者侧卧双肺通气(TLV)10 min(T1)、开胸OLV(即给药)10min(T2)、30min(T3)、60min(T4)的SBP、DBP、HR、CVP和SpO2值,做动静脉血气分析,计算肺内分流(Qs/Qt)。结果与T 1相比,U组在T 3、T 4时SBP、DBP降低；N组在T 2~T 4时SBP、DBP降低,在T 3、T 4时HR增快；两组患者在T2~T4时PaO2均降低,Qs/Qt 均增加,N 组患者在 T3、T4时 SpO2降低,在 T4时 PaCO2升高,差异有统计学意义(P <0.05)。与T 2相比,N组在T 3、T 4时SBP、DBP降低,PaO 2降低,Qs/Qt增加,SpO 2降低,在T 4时HR增快,差异有统计学意义(P<0.05)。与U组相比,N组在T2~T4时SBP降低,PaO2降低,在T3、T4时DBP降低,HR增快,Qs/Qt增加,SpO2降低,在T4时PaCO2升高,差异有统计学意义(P<0.05)。结论乌拉地尔和硝酸甘油均可降低高血压患者OLV期间的血压,均可增加肺内动静脉分流。但乌拉地尔对患者血液动力学和肺内动静脉分流的影响较小,更适合于高血压患者OLV期间对血压的控制。%Objective To compare the effects of urapidil and nitroglycerin on hemadynamics and intrapulmonary shunt during one-lung ventilation in hypertensive patients. Methods Sixty hypertensive patients undergoing thoracic surgery under gen-eral anesthesia with double-lumen tube were randomly divided into urapidil group( group U) and nitroglycerin group( group N) ,with 30 cases each. Patients received intravenous infusion of urapidil 4μg/( kg·min) ( group U) and nitroglycerin 2μg/( kg·min) ( group C) respectively during OLV. Oxygenation and hemodynamic parameters of the two groups were recorded 10 min after two lung ventilation and 10,30,60 min after OLV. At the same time blood gas analysis was determined and Qs/Qt was calculated. Re-sults Compared with TLV,SBP and DBP decreased while HR increased at OLV 30 and 60 min in two groups. PaO 2 decreased while Qs/Qt increased during OLV(P<0. 05). Compared with group U,SBP and PaO2 decreased while Qs/Qt increased during OLV in group N;DBP and SpO2 decreased while HR and Qs/Qt increased at OLV 30min and 60 min in group N(P<0. 05). Conclusion Urapidil and nitroglycerin can reduce the blood pressure of hypertension patients and increase intrapulmonary shunt during OLV. However urapidil has little effect on hemadynamics and intrapulmonary shunt in hypertensive patients,so it is better drugs to control blood pressure of hypertensive patients during OLV.