摘要
目的 研究地尔硫[艹卓]和硝普钠控制性降压对减少手术出血和心率的影响。方法 30例由同一组外科医生行腰椎椎板减压和脊柱内固定手术的患者随机分为2组：地尔硫[艹卓]组（n=16）和硝普钠组（n=14）。所有患者均静脉注射利多卡因1．5mg·kg＆-1，异丙酚1．5mg·kg^-1，芬太尼0．1mg和罗库溴铵1mg·kg^-1后进行气管插管，以异氟醚和芬太尼维持麻醉，手术切皮之前均实施控制性降压。地尔硫革的静脉负荷量为20μg·kg^-1，静脉输注起始剂量为2-5μg·kg·min^-1；硝普钠的静脉输注起始剂量为1μg·kg^-1·min^-1。根据患者的血压分别调整这2种药物的剂量，维持平均动脉压在55～65mmHg的范围内。比较2组患者的手术时间、手术所涉及的脊柱节段、出血量、输液量、尿量、心率变化以及血压恢复到基础水平的时间等指标。结果 2组患者在手术时间以及手术所涉及的脊柱节段、晶体液和胶体液的输入量以及尿量等方面均无统计学差异。地尔硫[艹卓]组患者的出血量和输血量明显低于硝普钠组。地尔硫[艹卓]组恢复基础血压的时间明显长于硝普钠组。另外，硝普钠组出现反射性心动过速的比例较高，为57．1％。而地尔硫[艹卓]组患者没有出现反射性心动过速，但有2例患者出现心动过缓。结论 本研究表明地尔硫[艹卓]可用于控制性降压，其降压效果安全、有效。与硝普钠相比，能有效地减少手术出血量而无反射性心动过速的发生。
Objective To compare the use of diltiazem （DT-Z） and nitroprusside （NPS） for controlled hypotemion during spinal surgery. Methods Thirty patients operated on by the same team of surgeom were randomly assigned to DTZ group （ n = 16） and NPS group （n = 14）. All patients were intubated after intravenous induction with lidocaine 1.5mg·kg^-1, propofol 1.5 mg·kg^-1, fentanyl 0.1 mg and recuronium 1 mg·kg^-1. The anesthesia was maintained by isoflurane and fentanyl, and a target mean arterial blood pressure （MBP） of 60 mmHg （range 55 - 65 mmHg） was achieved prior to skin incision. DTZ iv was started with a loading dose of 20μg·kg^-1 and maintained with 2 - 5μg·kg^-1·min^-1 to titrate the MBP. NPS infusion was begun at 1μg·kg^-1min^-1 and titrated to achieve the target MAP. Detailed items during the operation were closely observed and compared between the two groups. Results No significant differences were observed between the two groups in operation time, segments of the cord involved, fluid infusion and urine output. But the DTZ group had less blood loss or blood transfusion than NPS group. The time elapsed for restoration of the baseline MAP was longer in DTZ group. The incidence of reflex tachycardia was as high as 57.1% in NTZ group, but was nil in DTZ group, though there occurred two cases of bradycardia. Conclusion DTZ is a safe, effective drug for controlled hypotension, possessing superiories to NPS in minimizing blood loss and avoidance of reflex tachycardia.
出处
《徐州医学院学报》
CAS
2006年第1期26-29,共4页
Acta Academiae Medicinae Xuzhou
