尼卡地平和硝普钠在老年人颈动脉内膜剥脱术中控制性降压效果比较

发布时间：2019-08-07 20:21

【摘要】：目的观察比较尼卡地平和硝普钠在颈动脉内膜剥脱术时控制性降压的效果。方法择期全身麻醉下行颈动脉内膜剥脱术的患者50例,随机分为两组,每组25人。A组:控制性降压药选用硝普钠;B组:控制性降压药选用尼卡地平。监测并记录入室(T0)、手术开始后10 min(T1)、阻断颈动脉时(T2)、控制性降压后1 min(T3)、控制性降压后5 min(T4)及控制性降压后15 min(T5)各时间点的收缩压(SBP)及心率(HR)并记录术中室性期前收缩、心动过速、术后苏醒延迟、术后躁动以及寒战等不良反应的发生情况。结果与A组比较,B组在T3~T6时间段控制性降压时,达到预期血压的速度更快、更平稳,且心率更稳定。B组术中心律失常的发生率更小,术毕清醒更快,术后几乎不用升压药,预后更好。结论颈动脉内膜剥脱术患者术中应用尼卡地平干预进行控制性降压,可有效预防患者术中出现剧烈的血流动力学波动,避免因心率过快引起心肌氧耗增加导致的心肌缺血及心律失常。
[Abstract]:Objective to observe and compare the effects of nicardipine and sodium nitroprusside on controlled hypotension during carotid endarterectomy. Methods Fifty patients undergoing carotid endarterectomy under general anesthesia were randomly divided into two groups with 25 patients in each group. Group A: sodium nitroprusside and group B were treated with nicardipine. Systolic blood pressure (SBP) and heart rate (HR) were monitored and recorded at 10 min (T1) after operation, 10 min (T1) after operation, 1 min (T3) after controlled hypotension, 5 min (T 4) after controlled hypotension and 15 min (T5) after controlled hypotension. The occurrence of adverse reactions such as intraoperative ventricular premature contraction, tachycardia, delayed recovery after operation, restlessness and chills after operation were recorded. Results compared with group A, the rate of achieving expected blood pressure was faster, more stable and the heart rate was more stable in group B when controlled hypotension during T3~T6 time. The incidence of central rhythm disorder in group B was smaller, the postoperative awake was faster, there was little need of pressor drugs after operation, and the prognosis was better. Conclusion the intervention of nicardipine for controlled hypotension in patients with carotid endarterectomy can effectively prevent severe hemodynamic fluctuations during operation and avoid myocardial ischemia and arrhythmia caused by increased myocardial oxygen consumption caused by rapid heart rate.
【作者单位】：吉林省前卫医院麻醉科;吉林省肿瘤医院麻醉科;
【分类号】：R614

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