艾司洛尔降心率对鼻内镜术降压患者鼻血流、脑灌注、心输出量及术野的影响课案.doc

艾司洛尔降心率对鼻内镜术降压患者鼻血流、脑灌注、心输出量及术野的影响 纪存良 李天佐首都医科大学附属北京同仁医院【摘要】目的 评价。方法 择期内镜手术患者60例ASAI或II级，体重~85 kg ，＜30 kg/m2，性别不限，随机分为2组n = 30): 硝酸甘油降压组(组)和组(组）。静脉注射咪达唑仑、维库溴铵、异丙酚和瑞芬太尼麻醉诱导，置入可弯曲喉罩，行机械通气，吸入七氟烷维持麻醉。组静脉输注1 ~ 3 μg ?kg‐1 ? min‐1降压，组0 ~ 300 μg ?kg‐1 ? min‐1控制心率，术中维持BIS 40~ 60，维持MAP基础值70%。术毕待患者清醒拔出可弯曲喉罩。于麻醉诱导、记录MAP、HR、 、、采(Da-jvO2)、脑氧摄取率(CERO2) ，术毕Fromme评分）。结果 与组比较，组控制心率后 、和降低( 0.05)，Da-jvO2和CERO2差异无统计学意义（0.05)。结论降低 可。【关键词】心输出量；鼻粘膜血流；术野清晰度评分；鼻内镜手术；脑灌注Effects of heart rate decreased by esmolol on cardiac output，nasal mucosa blood flow , cerebral perfusion and surgical field during endoscopic sinus surgery under controlled hypotension Ji Cun-liang Li Tian-zuo Department of Anesthesiology，Beijing Tongren Hospital, Capital University of Medical Sciences, Beijing 100730, China Corresponding author: Li Tian-zuo , Email: trmzltz@126. com 【Abstract】 Objective To evaluate the effects of controlled heart rate by esmolol combined with induced hypotention nitroglycerin(NTG) on cardiac output ,nasal mucosa blood flow, cerebral perfusion and surgical field in patients undergoing endoscopic sinus surgery. Methods Sixty ASA I or II patients of both sexes, weighing 49-85 kg, body mass index(BMI)30 kg/m2 undergoing endoscopic sinus surgery were randomly divided into 2 groups ( n= 30 each): NTG group (group N) and combined NTG with esmolol group(group E). Anesthesia was induced with midazolam, propofol, remifentanil and vecuronium and maintained with sevoflurane combined with N2O，FLMA was inserted and the patients were mechanically ventilated. BIS was maintained at 40-55 and MAP at 70% of the basaeline value with NTG (1-3μg ?kg‐1 ? min‐1 ) infused during operation. Esmolol (50-300μg ?kg‐1 ? min‐1) was infused in Group E to controll HR. MAP , HR ,SV and CO were continuously monitored and recorded.BF was monitored and blood samples of radial artery and jugular blub were drawn before induced hypotention and 45 min after the beginning of induced hypotention and controlled heart rate，Da-jvO