应用乌拉地尔与硝酸甘油对全身麻醉鼻内窥镜手术患者每搏量变异度的影响
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摘要
目的探讨乌拉地尔与硝酸甘油对全身麻醉鼻内窥镜手术患者每搏量变异度(SVV)的影响。方法选取2018年3月—2018年9月择期在全身麻醉下行鼻内窥镜手术患者60例。根据应用药物不同分为对照组、乌拉地尔组和硝酸甘油组,每组20例。对照组不给予降压药物,乌拉地尔组和硝酸甘油组于手术开始时给予相应降压药物。分别记录患者手术时间、术中出血量,并比较3组入室时(T0)、控制性降压即刻(T1)、10 min(T2)和30 min(T3)时的心率(HR)、平均动脉压(MAP)、心指数(CI)和SVV,并观察不良事件发生情况。结果乌拉地尔组和硝酸甘油组术中出血量和手术时间较对照组减少(P<0.05)。T2和T3时,乌拉地尔组和硝酸甘油组的MAP均低于对照组以及T0和T1时(P<0.05),硝酸甘油组HR高于对照组和T1时(P<0.05)。T3时,乌拉地尔组和硝酸甘油组SVV高于对照组和T1时(P<0.05),硝酸甘油组HR高于T0时(P<0.05)。3组均无严重不良事件发生。结论应用乌拉地尔与硝酸甘油后SVV值升高,可能是低估了患者的容量状态,影响了SVV的准确性。
Objective To investigate effect of Urapidil and Nitroglycerin on stroke volume variation(SVV) in patients undergoing nasal endoscopic surgery under general anesthesia. Methods A total of 60 patients undergoing selective endoscopic nasal surgery under general anesthesia from March to September 2018 were divided into control group, Urapidil group and Nitroglycerin group(n=20 in each group) according to different medications. Control group did not be treated with antihypertensive drug, while antihypertensive drugs were implemented at the beginning of surgery in Urapidil and Nitroglycerin groups. Operative times and intraoperative bleeding volumes were recorded, and heart rate(HR), mean arterial pressure(MAP), cardiac index(CI) and SVV at the time of entering operating room(T0), at the time of deliberate hypotension(T1), after 10 min of deliberate hypotension(T2) and after 30 min of deliberate hypotension(T3) were compared, and incidence rates of adverse events were also recorded among three groups. Results Intraoperative bleeding volume and operative time in Urapidil and Nitroglycerin groups were significantly reduced compared with those in control group(P<0.05). MAP levels at T2 and T3 in Urapidil and Nitroglycerin groups were significantly lower than those in control group and at T0 and T1 in the same groups(P<0.05). HR level in Nitroglycerin group was significantly higher than those in control group and at T1 in the same group(P<0.05). SVV levels at T3 in Urapidil and Nitroglycerin groups were significantly higher than those in control group and at T1 in the same groups(P<0.05). HR level at T3 was significantly higher than at T0 in Nitroglycerin group(P<0.05). No severe adverse events were found among three groups. Conclusion SVV can be increased after using Urapidil and Nitroglycerin, and it maybe affects accuracy of SVV for evaluation patients' volume state.
Objective To investigate effect of Urapidil and Nitroglycerin on stroke volume variation(SVV) in patients undergoing nasal endoscopic surgery under general anesthesia. Methods A total of 60 patients undergoing selective endoscopic nasal surgery under general anesthesia from March to September 2018 were divided into control group, Urapidil group and Nitroglycerin group(n=20 in each group) according to different medications. Control group did not be treated with antihypertensive drug, while antihypertensive drugs were implemented at the beginning of surgery in Urapidil and Nitroglycerin groups. Operative times and intraoperative bleeding volumes were recorded, and heart rate(HR), mean arterial pressure(MAP), cardiac index(CI) and SVV at the time of entering operating room(T0), at the time of deliberate hypotension(T1), after 10 min of deliberate hypotension(T2) and after 30 min of deliberate hypotension(T3) were compared, and incidence rates of adverse events were also recorded among three groups. Results Intraoperative bleeding volume and operative time in Urapidil and Nitroglycerin groups were significantly reduced compared with those in control group(P<0.05). MAP levels at T2 and T3 in Urapidil and Nitroglycerin groups were significantly lower than those in control group and at T0 and T1 in the same groups(P<0.05). HR level in Nitroglycerin group was significantly higher than those in control group and at T1 in the same group(P<0.05). SVV levels at T3 in Urapidil and Nitroglycerin groups were significantly higher than those in control group and at T1 in the same groups(P<0.05). HR level at T3 was significantly higher than at T0 in Nitroglycerin group(P<0.05). No severe adverse events were found among three groups. Conclusion SVV can be increased after using Urapidil and Nitroglycerin, and it maybe affects accuracy of SVV for evaluation patients' volume state.
引文
[1] Li J,Ji F H,Yang J P.Evaluation of stroke volume variation obtained by the Flotrac/Vigileo system to guide preoperative fluid therapy in patients undergoing brain surgery[J].J Int Med Res,2012,40(3):1175-1181.
[2] Cannesson M,Musard H,Desebbe O,et al.The ability of stroke volume variations obtained with vigileo/flotrac system to monitor fluid responsiveness in mechanically ventilated patients[J].Anesth Analg,2009,108(2):513-517.
[3] 陈旭,陈蕾,张晓峰,等.肺叶切除术患者不同通气模式下每搏量变异度的变化[J].中华麻醉学杂志,2011,31(7):844-846.
[4] 蔡勤芳,袁维秀,米卫东.不同潮气量通气患者液体治疗时每搏量变异度判断扩容效应的阈值[J].中华麻醉学杂志,2010,30(7):817-819.
[5] 唐亮,裘毅敏,李士通.侧卧位开胸手术对每搏量变异度的影响[J].上海医学,2009,32(11):959-962.
[6] 赵艾华,贾卫爱,李超,等.每搏量变异度监测腹腔镜手术患者血容量变化的准确性[J].中华麻醉学杂志,2015,35(4):447-449.
[7] Kumar A,Anel R,Bunnell E,et al.Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume,cardiac performance,or the response to volume infusion in normal subjects[J].Crit Care Med,2004,32(3):691-699.
[8] Cavallaro F,Sandroni C,Antonelli M.Functional hemodynamic monitoring and dynamic indices of fluid responsiveness[J].Minerva Anestesiol,2008,74(4):123-135.
[9] 严国辉,刘赕呜,王敏.控制性降压在鼻内镜手术中的应用[J].中国冶金工业医学杂志,2011,28(1):54-55.
[10] 杨皖菁,周波,高中.耳鼻喉动力系统及内窥镜在腺样体手术应用[J].现代仪器与医疗,2013,19(3):41-43.
[11] 叶文炼,姜婉娜,金约西,等.不同降压水平对高血压患者眼鼻相关微创术后认知功能的影响[J].中国临床保健杂志,2014,17(4):396-398.
[12] Challand C,Struthers R,Sneyd J R,et al.Randomized controlled trail of intraoperative goal-directed fluid therapy in aerobically fit and unfit patient having major colorectal surgery[J].Br J Aneasth,2012,108(1):53-62.
[13] Benes J,Chytra I,Altmann P,et al.Intraoperative fluid optimization using stroke volume variation in high risk surgical patients:results of prospective randomized study[J].Crit Care,2010,14(3):R118.
[14] Forget P,Lois F,de Kock M.Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management[J].Anesth Analg,2010,111(4):910-914.
[15] 高景丽,王爱田,李晓岚,等.目标导向治疗中每搏变异度对液体复苏患者的影响[J].中国急救复苏与灾害杂志,2016,10(6):569-572.
[16] Button D,Weibel L,Reuthebuch O,et al.Clinical evaluation of the Flotrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery[J].Br J Anaesth,2007,99(3):329-336.
[17] Biais M,Nouette-Gaulain K,Cottenceau V,et al.Cardiac output measurement in patients undergoing liver transplantation:pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis[J].Anesth Analg,2008,106(5):1480-1486.
[18] Cannesson M,Attof Y,Rosamel P,et al.Comparison of flotrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements[J].Eur J Anaesthesiol,2007,24(10):832-839.
[19] Kim H K,Pinsky M R.Effect of tidal volume,sampling duration,and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation[J].Crit Care Med,2008,36(10):2858-2862.
[20] Lee J Y,Park H Y,Jung W S,et al.Comparative study of pressure-and volume-controlled ventilation on stroke volume variation as a predictor of fluid responsiveness in patients undergoing major abdominal surgery[J].J Crit Care,2012,27(5):531.
[21] Heenen S,De Backer D,Vincent J L.How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J].Crit Care,2006,10(4):R102.
[22] 陈宇,傅强,米卫东.俯卧位呼吸末正压对每搏量变异度、脉搏压变异度和脉搏灌注变异指数预测容量准确性及阈值的影响[J].中国医学科学院学报,2015,37(2):179-184.
[23] Hollenberg S M,Ahrens T S,Annane D,et al.Practice parameters for hemodynamic support of sepsis in adult patients:2004 update[J].Grit Care Med,2004,32(9):1928-1948.
[24] 何婧瑜,华琦.乌拉地尔在心血管疾病中的临床应用[J].首都医科大学学报,2013,34(1):100-104.
[25] 孔冉,米卫东,傅强.应用去氧肾上腺素后脉搏压变异度和每搏量变异度相关性研究[J].北京医学,2015,37(4):347-349.
[2] Cannesson M,Musard H,Desebbe O,et al.The ability of stroke volume variations obtained with vigileo/flotrac system to monitor fluid responsiveness in mechanically ventilated patients[J].Anesth Analg,2009,108(2):513-517.
[3] 陈旭,陈蕾,张晓峰,等.肺叶切除术患者不同通气模式下每搏量变异度的变化[J].中华麻醉学杂志,2011,31(7):844-846.
[4] 蔡勤芳,袁维秀,米卫东.不同潮气量通气患者液体治疗时每搏量变异度判断扩容效应的阈值[J].中华麻醉学杂志,2010,30(7):817-819.
[5] 唐亮,裘毅敏,李士通.侧卧位开胸手术对每搏量变异度的影响[J].上海医学,2009,32(11):959-962.
[6] 赵艾华,贾卫爱,李超,等.每搏量变异度监测腹腔镜手术患者血容量变化的准确性[J].中华麻醉学杂志,2015,35(4):447-449.
[7] Kumar A,Anel R,Bunnell E,et al.Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume,cardiac performance,or the response to volume infusion in normal subjects[J].Crit Care Med,2004,32(3):691-699.
[8] Cavallaro F,Sandroni C,Antonelli M.Functional hemodynamic monitoring and dynamic indices of fluid responsiveness[J].Minerva Anestesiol,2008,74(4):123-135.
[9] 严国辉,刘赕呜,王敏.控制性降压在鼻内镜手术中的应用[J].中国冶金工业医学杂志,2011,28(1):54-55.
[10] 杨皖菁,周波,高中.耳鼻喉动力系统及内窥镜在腺样体手术应用[J].现代仪器与医疗,2013,19(3):41-43.
[11] 叶文炼,姜婉娜,金约西,等.不同降压水平对高血压患者眼鼻相关微创术后认知功能的影响[J].中国临床保健杂志,2014,17(4):396-398.
[12] Challand C,Struthers R,Sneyd J R,et al.Randomized controlled trail of intraoperative goal-directed fluid therapy in aerobically fit and unfit patient having major colorectal surgery[J].Br J Aneasth,2012,108(1):53-62.
[13] Benes J,Chytra I,Altmann P,et al.Intraoperative fluid optimization using stroke volume variation in high risk surgical patients:results of prospective randomized study[J].Crit Care,2010,14(3):R118.
[14] Forget P,Lois F,de Kock M.Goal-directed fluid management based on the pulse oximeter-derived pleth variability index reduces lactate levels and improves fluid management[J].Anesth Analg,2010,111(4):910-914.
[15] 高景丽,王爱田,李晓岚,等.目标导向治疗中每搏变异度对液体复苏患者的影响[J].中国急救复苏与灾害杂志,2016,10(6):569-572.
[16] Button D,Weibel L,Reuthebuch O,et al.Clinical evaluation of the Flotrac/Vigileo system and two established continuous cardiac output monitoring devices in patients undergoing cardiac surgery[J].Br J Anaesth,2007,99(3):329-336.
[17] Biais M,Nouette-Gaulain K,Cottenceau V,et al.Cardiac output measurement in patients undergoing liver transplantation:pulmonary artery catheter versus uncalibrated arterial pressure waveform analysis[J].Anesth Analg,2008,106(5):1480-1486.
[18] Cannesson M,Attof Y,Rosamel P,et al.Comparison of flotrac cardiac output monitoring system in patients undergoing coronary artery bypass grafting with pulmonary artery cardiac output measurements[J].Eur J Anaesthesiol,2007,24(10):832-839.
[19] Kim H K,Pinsky M R.Effect of tidal volume,sampling duration,and cardiac contractility on pulse pressure and stroke volume variation during positive-pressure ventilation[J].Crit Care Med,2008,36(10):2858-2862.
[20] Lee J Y,Park H Y,Jung W S,et al.Comparative study of pressure-and volume-controlled ventilation on stroke volume variation as a predictor of fluid responsiveness in patients undergoing major abdominal surgery[J].J Crit Care,2012,27(5):531.
[21] Heenen S,De Backer D,Vincent J L.How can the response to volume expansion in patients with spontaneous respiratory movements be predicted?[J].Crit Care,2006,10(4):R102.
[22] 陈宇,傅强,米卫东.俯卧位呼吸末正压对每搏量变异度、脉搏压变异度和脉搏灌注变异指数预测容量准确性及阈值的影响[J].中国医学科学院学报,2015,37(2):179-184.
[23] Hollenberg S M,Ahrens T S,Annane D,et al.Practice parameters for hemodynamic support of sepsis in adult patients:2004 update[J].Grit Care Med,2004,32(9):1928-1948.
[24] 何婧瑜,华琦.乌拉地尔在心血管疾病中的临床应用[J].首都医科大学学报,2013,34(1):100-104.
[25] 孔冉,米卫东,傅强.应用去氧肾上腺素后脉搏压变异度和每搏量变异度相关性研究[J].北京医学,2015,37(4):347-349.