硝酸甘油对垂体后叶素诱发的腹腔镜子宫肌瘤切除术患者心血管反应的效果
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摘要
目的探讨硝酸甘油对腹腔镜子宫肌瘤切除术中垂体后叶素诱发的心血管反应的有效性。方法选择2017年9月至2018年4月在青岛市市立医院拟于全麻下择期行腹腔镜子宫肌瘤切除术的患者80例,ASAⅠ或Ⅱ级,年龄31～55岁,体重指数(body mass index,BMI)18.5～24.0kg/m~2,随机分为对照组(C组)和硝酸甘油组(N组),每组40例。术中维持脑电双频指数(bispectral index,BIS)45～55。所有患者均于子宫肌瘤切除操作前,在子宫肌瘤周围肌层注射垂体后叶素6U+生理盐水共20ml。N组于注射完毕后30s静脉滴注硝酸甘油25μg,同时给予硝酸甘油1000μg+0.9%氯化钠共20ml静脉泵注,泵注速度为0.3μg/(kg·min),泵注20min后停药。观察患者注射垂体后叶素前1min(T_0)及注射后30s(T_1)、1min(T_2)、90s(T_3)、2min(T_4)、5min(T_5)、10min(T_6)、20min(T_7)、30min(T_8)的平均动脉压、心率,记录手术时间以及术中出血量。结果与T_0时比较,两组患者在T_1、T_2时平均动脉压明显降低(P<0.01),心率明显增快(P<0.01);在T_4～T_7时C组平均动脉压明显升高(P<0.05),N组平均动脉压、心率无明显改变;在T_4、T_5时C组心率明显下降(P<0.05)。与C组比较,T_4～T_7时N组平均动脉压明显降低(P<0.05),心率明显增快(P<0.05)。两组手术时间及出血量差异均无显著性(P>0.05)。结论硝酸甘油能有效改善腹腔镜子宫肌瘤切除术中应用垂体后叶素诱发的心血管反应,避免出现脑出血、心跳骤停等严重并发症。
Objective To investigate the efficacy of Nitroglycerin in preventing pituitrin-induced cardiovascular responses in patients undergoing laparoscopic hysteromyomectomy.Method Eighty patients(ASAⅠorⅡ),aged 31-55 years,body mass index(BMI)18.5-24.0kg/m~2,Scheduled for laparoscopic hysteromyomectomy under general anesthesia were randomly assigned into two groups:control group(group C)and nitroglycerin group(group N).BIS value was maintained at 45-55.The mixture of pituitrin 6U and normal saline 20ml was injected into the site of hysteromyoma.30 seconds later,25μg of nitroglycerin were injected intravenously in group N while the nitroglycerin were continous pumping at 0.3μg/(kg·min).The mean blood pressure and heart rate were recorded at 1min(T_0)before injection of pituitrin,30s(T_1),1min(T_2),90s(T_3),2min(T_4),5min(T_5),10min(T_6),20min(T_7),30min(T_8) after injection.The operation time and the amount of bleeding were also measured at last.Result Compared with T_0,the MAP were significantly decreased(P<0.05)and the HR were increased at T_1 and T_2(P<0.05)in two groups;the MAP was increased significantly at T_4-T_7(P<0.05)in group C;the MAP and HR had no statistical differences at T_4-T_7 in group N;the HR at T_4 and T_5 were marked decreased(P<0.05)in group C.Compared with Group C,the MAP was significantly lower(P<0.05)and the HR was higher(P<0.05)at T_4-T_7.The operation time and the amount of bleeding in the two groups had no statistical differences.Conclusion Nitroglycerin is effective for the prevention of cardiovascular responses that induced by pituitrin in patients with laparoscopy hysteromyomectomy,so that can reduce the risk of adverse.
Objective To investigate the efficacy of Nitroglycerin in preventing pituitrin-induced cardiovascular responses in patients undergoing laparoscopic hysteromyomectomy.Method Eighty patients(ASAⅠorⅡ),aged 31-55 years,body mass index(BMI)18.5-24.0kg/m~2,Scheduled for laparoscopic hysteromyomectomy under general anesthesia were randomly assigned into two groups:control group(group C)and nitroglycerin group(group N).BIS value was maintained at 45-55.The mixture of pituitrin 6U and normal saline 20ml was injected into the site of hysteromyoma.30 seconds later,25μg of nitroglycerin were injected intravenously in group N while the nitroglycerin were continous pumping at 0.3μg/(kg·min).The mean blood pressure and heart rate were recorded at 1min(T_0)before injection of pituitrin,30s(T_1),1min(T_2),90s(T_3),2min(T_4),5min(T_5),10min(T_6),20min(T_7),30min(T_8) after injection.The operation time and the amount of bleeding were also measured at last.Result Compared with T_0,the MAP were significantly decreased(P<0.05)and the HR were increased at T_1 and T_2(P<0.05)in two groups;the MAP was increased significantly at T_4-T_7(P<0.05)in group C;the MAP and HR had no statistical differences at T_4-T_7 in group N;the HR at T_4 and T_5 were marked decreased(P<0.05)in group C.Compared with Group C,the MAP was significantly lower(P<0.05)and the HR was higher(P<0.05)at T_4-T_7.The operation time and the amount of bleeding in the two groups had no statistical differences.Conclusion Nitroglycerin is effective for the prevention of cardiovascular responses that induced by pituitrin in patients with laparoscopy hysteromyomectomy,so that can reduce the risk of adverse.
引文
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[3]魏敏.腹腔镜肌壁间子宫肌瘤剔除术应用垂体后叶素及缩宫素止血的疗效比较[J].中国基层医药,2014,21(5):660-662.
[4]马洪菊.手术预处理对腹腔镜下子宫肌瘤剔除术效果的影响观察[J].中国实用医药,2018,13(9):60-61.
[5]Kimura T,Kusui C,Matsumura Y,et al.Effectiveness of hormonaltourniquet by vasopressin during myomectomy through vasopressin via receptorubiquitously expressed in myometrium[J].Gynecol Obstet Invest,2002,54(3):125-131.
[6]郭晓光,韩传宝,钱燕宁.佩尔地平对垂体后叶素诱发腹腔镜子宫肌瘤剔除术患者心血管反应的效果[J].临床麻醉学杂志,2013,29(5):432-434.
[7]张晓春.腹腔镜下子宫肌瘤切除术中手术技巧探讨[J].中国医刊.2014,49(2):73-74.
[8]赵国胜,赵恩慈.腹腔镜下子宫肌瘤剔除术中联合应用垂体后叶素与催产素对循环系统的影响[J].临床麻醉学杂志,2012,28(5):485-487.
[9]王海霞,陈丽.垂体后叶素诱发腹腔镜子宫肌瘤剔除术患者心血管反应的研究进展[J].当代医学,2015,21(5):12-14.
[10]Agostini A,Ronda I,Frenchi F,et al.Oxymcin during myomectomy:a randomized study[J].Eur J Obstet Gynecol Reprod Biol,2005,118(2):235-238.
[11]Matthias L,Riess Jason G,Ulrichs Paul S,et al.Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin[J].Anesth Analg,2011,113(5):1103-1105.
[12]Park KS,Yoo KY.Role of vasopressin in current anesthetic practice[J].Korean J Anesthesiol,2017,70(3):245-257.
[13]Zeqja E,Qirko R.Vasopressine in laparoscopic myomectomy,a review over the effectiveness,dosage and possible complications[J].IOSR J Pharm,2016,6(6):23-27.
[14]Münzel T,Gori T.Nitrate therapy and nitrate therapy and nitrate tolerance in patients with coronary disease[J].Curr Opin Pharmacol,2013,13(2):251-259.
[15]何婧瑜,周玉杰,付研.乌拉地尔与硝酸甘油注射液治疗高血压合并急性心力衰竭患者有效性及安全性研究[J].中华老年心脑血管杂志,2016,18(7):676-680.
[2]詹慧旦,郑锦萍.1例垂体后叶素致心肌梗死的急救和护理[J].全科护理,2015,13(14):1367-1368.
[3]魏敏.腹腔镜肌壁间子宫肌瘤剔除术应用垂体后叶素及缩宫素止血的疗效比较[J].中国基层医药,2014,21(5):660-662.
[4]马洪菊.手术预处理对腹腔镜下子宫肌瘤剔除术效果的影响观察[J].中国实用医药,2018,13(9):60-61.
[5]Kimura T,Kusui C,Matsumura Y,et al.Effectiveness of hormonaltourniquet by vasopressin during myomectomy through vasopressin via receptorubiquitously expressed in myometrium[J].Gynecol Obstet Invest,2002,54(3):125-131.
[6]郭晓光,韩传宝,钱燕宁.佩尔地平对垂体后叶素诱发腹腔镜子宫肌瘤剔除术患者心血管反应的效果[J].临床麻醉学杂志,2013,29(5):432-434.
[7]张晓春.腹腔镜下子宫肌瘤切除术中手术技巧探讨[J].中国医刊.2014,49(2):73-74.
[8]赵国胜,赵恩慈.腹腔镜下子宫肌瘤剔除术中联合应用垂体后叶素与催产素对循环系统的影响[J].临床麻醉学杂志,2012,28(5):485-487.
[9]王海霞,陈丽.垂体后叶素诱发腹腔镜子宫肌瘤剔除术患者心血管反应的研究进展[J].当代医学,2015,21(5):12-14.
[10]Agostini A,Ronda I,Frenchi F,et al.Oxymcin during myomectomy:a randomized study[J].Eur J Obstet Gynecol Reprod Biol,2005,118(2):235-238.
[11]Matthias L,Riess Jason G,Ulrichs Paul S,et al.Severe vasospasm mimics hypotension after high-dose intrauterine vasopressin[J].Anesth Analg,2011,113(5):1103-1105.
[12]Park KS,Yoo KY.Role of vasopressin in current anesthetic practice[J].Korean J Anesthesiol,2017,70(3):245-257.
[13]Zeqja E,Qirko R.Vasopressine in laparoscopic myomectomy,a review over the effectiveness,dosage and possible complications[J].IOSR J Pharm,2016,6(6):23-27.
[14]Münzel T,Gori T.Nitrate therapy and nitrate therapy and nitrate tolerance in patients with coronary disease[J].Curr Opin Pharmacol,2013,13(2):251-259.
[15]何婧瑜,周玉杰,付研.乌拉地尔与硝酸甘油注射液治疗高血压合并急性心力衰竭患者有效性及安全性研究[J].中华老年心脑血管杂志,2016,18(7):676-680.