【摘要】 目的探讨硝酸甘油联合艾司洛尔控制性降压结合急性高容血液稀释(acute hypervolemic hemodilution,AHH)在鼻内镜手术中的应用效果。方法选择鼻内镜手术ASA I～Ⅱ级的患者40例。随机分为硝酸甘油组(A组,n=20)和硝酸甘油联合艾司洛尔组(B组,n=20)。术前采用乳酸林格氏液及6%羟乙基淀粉急性高容量血液稀释,术中硝酸甘油组微量泵注硝酸甘油0.5～5.0μg/(kg·min);硝酸甘油联合艾司洛尔组微量泵注硝酸甘油0.5～5.0μg/(kg·min),同时艾司洛尔0.01～0.02 mg/(kg·min)泵注维持,记录两组患者手术过程中MAP、HR、出血量及术野质量评分等。结果 B组硝酸甘油用量显著少于A组(P<0.05);A组降压期间HR增快,较降压前差异有统计学意义(P<0.05),B组降压期间HR轻度下降,与A组比较差异有统计学意义(P<0.05);两组MAP均较术前显著降低,45min时,B组MAP值显著小于A组;两组均未出现明显降压性并发症。结论硝酸甘油联合艾司洛尔控制性降压可以安全有效地应用于鼻内镜手术,结合急性血液稀释可明显减少术中出血量。更多还原

【Abstract】 Objective To evaluate the effects between nitroglycerin and nitroglycerin combined with esmolol during deliberate hypotension combined with acute hypervolemic hemodilution(AHH) in endoscopic nasal surgery. Methods Forty ASA grade Ⅰto Ⅱ patients undergoing selective endoscopic nasal surgery were randomly divided into two groups:nitroglycerin group(group A,n=20) and nitroglycerin combined with esmolol group(group B,n=20).Lactated Ringer’s solution and hydroxyethyl starch(6%,g/ml)were used for diluting blood before operation.During operation,nicardipine was pumped in at the speed of 0.5～5.0 μg/(kg·min),for nitroglycerin combined with esmolol was 0.5～5.0 μg/(kg·min),esmolol was kept pumping in at the speed of 0.01～0.02 μg/(kg·min).MAP,the quality of surgery field,heart rate(HR) and blood loss of the patients were recorded. Results Dosage of nicardipine of group B was significant lower than that of group A(P<0.05);there was an significant difference in HR between two groups(P<0.05),HR of group A increased quickly during operation(P<0.05),HR of group B decreased slowly;MAP of two groups decreased apparently during operation,MAP of group B was significantly lower than that of group A in the 45th minute.There was no evident complication of controlled hypotension in both groups. Conclusions Nicardipine combined with esmolol can be safely applied in controlled hypotension of anesthesia in endoscopic nasal surgery;can significantly reduce the intraoperative blood loss while combined with AHH.更多还原