摘要
目的 比较尼卡地平和硝酸甘油在体外循环中控制高血压的效果及对血流动力学的影响。方法40例冠状动脉旁路术 (CABG)病人在体外循环 (CPB)中平均动脉压升至 10 .7kPa时给予尼卡地平或硝酸甘油。将病人随机分为尼卡地平和硝酸甘油组 ,每组 2 0例。观察两药起效时间 ,维持平均动脉压 (MAP)在 6 .6 5～ 9.31kPa时所需剂量 ,开放升主动脉后心脏自动复跳情况以及停机后血流动力学的变化。结果 将MAP从 10 .7kPa降至 6 .6 5～ 9.31kPa时 ,应用尼卡地平 0 .5mg ,所需时间为 (3 .8± 1.3)min ,维持MAP在 6 .6 5～ 9.31kPa时所需剂量为 (1.2± 0 .4) μg·kg-1·min-1,其中有 1例发生耐药 ,增加剂量可将血压控制在目标范围。应用硝酸甘油 3μg·kg-1·min-1,所需时间为 (16 .4± 8.4)min ,维持MAP在 6 .6 5～ 9.31kPa时所需剂量为 (2 .2± 0 .2 )μg·kg-1·min-1,其中有 5例需改用硝普钠方能控制血压。尼卡地平组有 17例 (85 % )、硝酸甘油有 9例 (4 5 % )在开放升主动脉后心脏自动复跳 ,尼卡地平组自动复跳率明显高于硝酸甘油组 (P <0 .0 5 ) ,停机后两组体循环阻力 (SVR)均较CPB前明显降低 ,每搏量 (SV)和心指数 (CI)则明显增加 ,但组间比较差异无显著性。结论 CPB中控制高血压 ,尼卡地平与硝酸甘油相比 。
Objective To compare the effects of nicardipine and with nitroglycerin during CPB. Methods Forty patients underwent CBAG and were treated with nicardipine (Group N,n=20) or nitroglycerin (Group C, n=20) when MAP increased to 10.7 kPa during CPB. The onset and dosage to maintain MAP at 6.65～9.31 kPa were recorded. The hemodynamic parameters were monitored pre and post CPB.Results The time required of using bolus dose 0.5 mg of nicardipine to reduce MAP from 10.7 kPa to 9.31 kPa was 3.8±1.3 min, and to maintain MAP at 6.65～9.31 kPa at the required dosage of 1.2±0.4 μg·kg -1 ·min -1 . Whereas that using nitrates 3 μg·kg -1 ·min -1 to decrease MAP from 10.7 kPa to 9.31 kPa was 16.4±8.4 min, and to maintain MAP at 6.65～9.31 kPa, the required dose was (2.2±0.2) μg·kg -1 ·min -1 . 17 patients in group N and 9 patients in group C had restored spontaneous heart beat following release of aortic crossclamp, the rate was higher in group N than that in group C. SVR decreased and SV, CI increased significantly in both groups. RPP (MAP×HR) was lower in group N than that in group C 30 min after cessation of CPB. Conclusion In comparison with nitroglycerin, nicardipine shows some advantages in the treatment of hypertension during CPB undergoing CABG: myocardical oxygen consumption can be decreased and it is beneficial in protection of heart, brain and other organs, being more rapid in action and does not influence the capacitance vessels.
出处
《上海医学》
CAS
CSCD
北大核心
2001年第1期26-28,共3页
Shanghai Medical Journal
