高血压腹部手术患者术中乌拉地尔复合艾司洛尔控制性降压的可行性研究
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摘要
目的探讨高血压腹部手术患者术中乌拉地尔复合艾司洛尔控制性降压的可行性。方法选取在本院因腹部疾病行择期手术治疗的80例高血压患者,随机分为对照组与观察组,各40例,两组术中麻醉用药一致,对照组给予乌拉地尔控制性降压,观察组给予乌拉地尔复合艾司洛尔控制性降压,患者麻醉前(T0)、降压后10 min(T1)、降压后60 min(T2)、停止降压后15 min(T3)时平均动脉压(MAP),观察手术时间、术中出血量、输液尿、尿量。结果两组手术时间、尿量比较差异无统计学意义,术中出血量及输液量观察组分别为(330.63±40.56)ml、(3311.83±213.07)ml,少于对照组(375.91±42.19)ml、(3 484.88±244.75)ml(P<0.05);T0、T1、T2、T3时点MAP对照组为(89.14±7.24)mm Hg、(70.05±4.14)mm Hg、(68.16±4.58)mm Hg、(86.32±7.11)mm Hg,观察组为(90.02±7.18)mm Hg、(70.62±4.24)mm Hg、(69.23±5.13)mm Hg、(87.44±7.35)mm Hg,两组T1、T2时MAP较均较T0时下降(P<0.05)。结论高血压腹部手术患者术中乌拉地尔复合艾司洛尔控制性降压血压波动小,安全可靠,有助于减少术中出血量。
Objective To investigate the feasibility of urapidil combined with esmolol in controlled hypotension during abdominal surgery for hypertension.Methods In our hospital from 80 cases of hypertension treatment in patients with abdominal disease undergoing elective surgery,were randomly divided into control group and observation group,40 cases in each group,the two groups were consistent with general anesthesia,the control group was given urapidil on controlled hypotension,the observation group was given esmolol,urapidil combined Rockwell controlled hypotension,patients before anesthesia(T0),10 min after hypotension(T1),60 min after hypotension(T2),15 min after hypotension(T3) mean arterial pressure(MAP),the operation time,bleeding volume,urine volume,urine infusion.Results There was no statistical significance between the two groups in operation time,urine volume difference,and the amount of intraoperative transfusion volume of bleeding in the observation group were(330.63±40.56) ml,(3 311.83±213.07) ml,less than that of the control group(375.91±42.19) ml,(3 484.88±244.75) ml(P<0.05); T0,T1,T2,T3 at MAP for the control group(89.14±7.24)mm Hg,(70.05±4.14)mm Hg,(68.16±4.58)mm Hg,(86.32±7.11)mm Hg,the observation group was(90.02±7.18)mm Hg,(70.62 ± 4.24)mm Hg,(69.23 ± 5.13)mm Hg,(87.44 ± 7.35)mm Hg,T1,T2 two groups of MAP were decreased at T0(P<0.05).Conclusion Urapidil combined with esmolol is a safe and reliable method for controlling hypotension and hypotension in hypertensive patients undergoing abdominal surgery.It is helpful to reduce the amount of bleeding during operation.
Objective To investigate the feasibility of urapidil combined with esmolol in controlled hypotension during abdominal surgery for hypertension.Methods In our hospital from 80 cases of hypertension treatment in patients with abdominal disease undergoing elective surgery,were randomly divided into control group and observation group,40 cases in each group,the two groups were consistent with general anesthesia,the control group was given urapidil on controlled hypotension,the observation group was given esmolol,urapidil combined Rockwell controlled hypotension,patients before anesthesia(T0),10 min after hypotension(T1),60 min after hypotension(T2),15 min after hypotension(T3) mean arterial pressure(MAP),the operation time,bleeding volume,urine volume,urine infusion.Results There was no statistical significance between the two groups in operation time,urine volume difference,and the amount of intraoperative transfusion volume of bleeding in the observation group were(330.63±40.56) ml,(3 311.83±213.07) ml,less than that of the control group(375.91±42.19) ml,(3 484.88±244.75) ml(P<0.05); T0,T1,T2,T3 at MAP for the control group(89.14±7.24)mm Hg,(70.05±4.14)mm Hg,(68.16±4.58)mm Hg,(86.32±7.11)mm Hg,the observation group was(90.02±7.18)mm Hg,(70.62 ± 4.24)mm Hg,(69.23 ± 5.13)mm Hg,(87.44 ± 7.35)mm Hg,T1,T2 two groups of MAP were decreased at T0(P<0.05).Conclusion Urapidil combined with esmolol is a safe and reliable method for controlling hypotension and hypotension in hypertensive patients undergoing abdominal surgery.It is helpful to reduce the amount of bleeding during operation.
引文
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[2]刘佳梅,刘佳,蔡军,等.原发性高血压相关代谢组学的初步研究[J].中华高血压杂志,2016,24(4):340-347.
[3]邓婷婷,周素娴.2型糖尿病合并高血压患者血脂,血糖代谢情况及其与高血压病程的关系[J].广东医学,2014,35(5):722-724.
[4]殷玥琪,杨立刚,孙桂菊.高脂血症与高血压相关性及其代谢异常研究进展[J].中国老年学杂志,2014,34(5):1414-1417.
[5]祝之明.代谢性高血压的概念提出与临床实践:我的探索之路[J].中华糖尿病杂志,2017,9(1):9-13.
[6]陈晓梅,陈广福.右美托咪定对颅内肿瘤手术患者血流动力学的影响及脑保护作用[J].临床麻醉学杂志,2015,31(1):15-17.
[7]王雄伟,陈晖.瑞芬太尼复合右美托咪定在心脏手术中的麻醉效果及对患者血流动力学的影响[J].实用药物与临床,2013,16(9):799-801.
[8]吴萍,林梓霞,郑良杰,等.脊柱手术中血液稀释,控制性降压联合血液回收减少术中出血效果观察[J].山东医药,2014,54(30):89-90.
[9]王菲,骆喜宝,刘志贵,等.控制性降压联合氨甲环酸对脑肿瘤手术围术期出血量和凝血功能的影响[J].实用医学杂志,2016,32(14):2253-2255.
[10]谭军源,张小丹,郭璐娣.探究硬膜外控制性降压对全髋置换手术术中出血量的影响[J].中国实用医药,2016,11(10):195-196.
[11]张乐乐,方剑乔,邵晓梅,等.TEAS复合药物全麻对控制性降压至60%基础MAP水平时的胃动力变化影响[J].中国中西医结合杂志,2015,35(1):98-103.
[12]唐金良,林高翔.乌拉地尔复合艾司洛尔控制性降压在高血压患者脊柱手术中的应用[J].当代医学,2013,19(2):148-150.
[13]侯锐,吴芳,何黎升,等.高血压拔牙患者控制性降压的随机双盲临床研究[J].中国口腔颌面外科杂志,2014,12(1):51-55.
[14]Diemunsch P,Garcia V,Lyons G,et al.Urapidil versus nicardipine in preeclamptic toxaemia:a randomised feasibility study[J].European Journal of Anaesthesiology(EJA),2015,32(11):822-823.
[15]任江,江华.鼻内镜手术应用乌拉地尔联合艾司洛尔控制性降压的可行性分析[J].当代医学,2016,22(16):134-135.