乌拉地尔预防颈丛阻滞心血管应激反应的临床研究(1)
【摘要】 目的 观察乌拉地尔和利多卡因配伍对颈丛阻滞心血管应激反应的防治作用。方法 选择40例甲状腺类手术患者，随机分为两组各20例。所有患者均以C4一针法阻滞，阻滞液为A组1.25%利多卡因液30 ml，B组1.25%利多卡因+乌拉地尔0.4~0.5 mg/kg混合液30 ml。两组患者均常规鼻导管吸氧，切皮前静脉注射芬太尼0.1 mg和氟哌利多5 mg。持续监测心电图、SpO2 、血压，并在各时点抽血查血浆去甲肾上腺素(NE)和肾上腺素(E)的含量。结果 B组患者阻滞前各观察指标无变化(P>0.05);A组患者阻滞后5、10 min 较阻滞前和B组间有明显变化(P<0.01)。血浆NE和E，A组阻滞后较阻滞前和B组间有变化(P<0.05)。结论 乌拉地尔配伍利多卡因能有效地抑制颈丛阻滞后交感神经活性增强引起循环系统的不良反应。
【关键词】 乌拉地尔；利多卡因；颈丛阻滞；应激反应
Clinical study of the prevention effect of urapidil to the cardiovascular stress in cervical plexus blockade patients
, 百拇医药
YAN Dao-ming, WANG Kai-xiang.Wangkai Infectious Hospital,Zaozhuang,Shandong 277500,China
【Abstract】 Objective To study the prevention effect of urapidil with lidocaine to the cardiovascular stress in the cervical plexus blockade patients.Methods Forty patients undergoing thyroidectomy were randomly divided into two groups of twenty each.All the paients were anesthetized in the C 4 block.Group A with 1.25%lidocaine 30 ml,and the group B were usedwith 1.25%lidocaineand urapidil0.4-0.5 mg/kg combined30 ml.Oxygen was inhaled routinely through nasal tube during operation.Fentanyl 0.1 mg and droperidol5 mg were injected in the vein incision.The electrocardiogram，SpO2,blood pressure were monitored continually.The noradenaline(NE)and adrenalin(E)plasma concentration were also measured.Results There were no significant differences in group A and group B (P>0.05)，the changes of MAP after5 minutes and10 minutes blockade in group A are significantly different than that in group B (P<0.01).The MAP after block was more lower than that before block.The serum NE and E level between pre-block and post block in group A were more different than that in group B (P<0.05).Conclusion Urapidil and lidocaine can effectively depress sympathetic responses to cervical plexus block.
, http://www.100md.com
【Key words】 Urapidil;Lidocaine;Cervical plexus;Block stress
颈丛阻滞常致血压升高，始自注药后5 min，15~20 min达高峰，且伴有不同程度心率增快，其原因可能为颈动脉窦及迷走神经被阻滞，交感神经活性增强，对并存心脑血管疾病的患者具有潜在的危害性[1]。本文用乌拉地尔(urapidil)与利多卡因复合液施行颈丛阻滞，观察其对血浆去甲肾上腺素(NE)和肾上腺素(E)的影响，进而探讨颈丛阻滞后交感神经活性及造成循环系统不良反应的原因。现报告如下。
1 资料与方法
1.1 一般资料 选择40例甲状腺类手术患者，男9例，女31例，年龄23~56岁。ASAⅠ~Ⅱ级，均无高血压、心脏病。随机分为对照组(A组)和试验组(B组)各20例。
1.2 麻醉方法 所有患者术前30 min常规肌内注射苯巴比妥钠0.1 g和东莨菪碱0.3 mg，均以C4一针法施双侧颈浅丛放射状和单侧深丛阻滞。A组1.25%利多卡因液30 ml，B组1.25%利多卡因+乌拉地尔0.4~0.5 mg/kg混合液30 ml，每侧15 ml。药液均未加肾上腺素。两组患者均常规鼻导管吸氧，切皮前静脉注射芬太尼0.1 mg和氟哌利多5 mg。
, http://www.100md.com
1.3 观察指标 分别于阻滞前(T1)和阻滞后5(T2)、10(T3)、20(T4)、30 min (T5)所有患者均持续监测心电图、SpO6，记录收缩压(SP)、舒张压(DP)、平均动脉压(MAP)及心率(HR)，并在以上各时点抽前臂静脉血5 ml，加入抗凝剂，离心后取血浆置于0℃贮藏室内，用液相色谱电化法测定NE和E含量。
1.4 统计学方法 测定结果采用SPSS 10.0软件包进行统计学处理，计量资料用均数±标准差(x±s)表示，组内比较用配对t检验。组间用两样本均数t检验。P<0.05表示差异有统计学意义。
2 结果
两组患者年龄、性别、体质量、病种、手术时间均无统计学差异(P>0.05)。观察期间SpO2 均大于96%，均未出现心律失常。A组SP、DP、MAP、HR阻滞前后各观察指标均有变化(P<0.05)，各时相(T2~T5)与其T1比较显著增高(P<0.01)。B组于T2~T4时较其T1增高(P<0.05)，但SP、DP、MAP、于T2~T5及HR于T4、T5时均显著低于A组(P<0.01) 血浆NE和E，A组阻滞后较阻滞前和B组间有变化(P<0.05)。, 百拇医药(颜道明 王开祥)
【关键词】 乌拉地尔；利多卡因；颈丛阻滞；应激反应
Clinical study of the prevention effect of urapidil to the cardiovascular stress in cervical plexus blockade patients
, 百拇医药
YAN Dao-ming, WANG Kai-xiang.Wangkai Infectious Hospital,Zaozhuang,Shandong 277500,China
【Abstract】 Objective To study the prevention effect of urapidil with lidocaine to the cardiovascular stress in the cervical plexus blockade patients.Methods Forty patients undergoing thyroidectomy were randomly divided into two groups of twenty each.All the paients were anesthetized in the C 4 block.Group A with 1.25%lidocaine 30 ml,and the group B were usedwith 1.25%lidocaineand urapidil0.4-0.5 mg/kg combined30 ml.Oxygen was inhaled routinely through nasal tube during operation.Fentanyl 0.1 mg and droperidol5 mg were injected in the vein incision.The electrocardiogram，SpO2,blood pressure were monitored continually.The noradenaline(NE)and adrenalin(E)plasma concentration were also measured.Results There were no significant differences in group A and group B (P>0.05)，the changes of MAP after5 minutes and10 minutes blockade in group A are significantly different than that in group B (P<0.01).The MAP after block was more lower than that before block.The serum NE and E level between pre-block and post block in group A were more different than that in group B (P<0.05).Conclusion Urapidil and lidocaine can effectively depress sympathetic responses to cervical plexus block.
, http://www.100md.com
【Key words】 Urapidil;Lidocaine;Cervical plexus;Block stress
颈丛阻滞常致血压升高，始自注药后5 min，15~20 min达高峰，且伴有不同程度心率增快，其原因可能为颈动脉窦及迷走神经被阻滞，交感神经活性增强，对并存心脑血管疾病的患者具有潜在的危害性[1]。本文用乌拉地尔(urapidil)与利多卡因复合液施行颈丛阻滞，观察其对血浆去甲肾上腺素(NE)和肾上腺素(E)的影响，进而探讨颈丛阻滞后交感神经活性及造成循环系统不良反应的原因。现报告如下。
1 资料与方法
1.1 一般资料 选择40例甲状腺类手术患者，男9例，女31例，年龄23~56岁。ASAⅠ~Ⅱ级，均无高血压、心脏病。随机分为对照组(A组)和试验组(B组)各20例。
1.2 麻醉方法 所有患者术前30 min常规肌内注射苯巴比妥钠0.1 g和东莨菪碱0.3 mg，均以C4一针法施双侧颈浅丛放射状和单侧深丛阻滞。A组1.25%利多卡因液30 ml，B组1.25%利多卡因+乌拉地尔0.4~0.5 mg/kg混合液30 ml，每侧15 ml。药液均未加肾上腺素。两组患者均常规鼻导管吸氧，切皮前静脉注射芬太尼0.1 mg和氟哌利多5 mg。
, http://www.100md.com
1.3 观察指标 分别于阻滞前(T1)和阻滞后5(T2)、10(T3)、20(T4)、30 min (T5)所有患者均持续监测心电图、SpO6，记录收缩压(SP)、舒张压(DP)、平均动脉压(MAP)及心率(HR)，并在以上各时点抽前臂静脉血5 ml，加入抗凝剂，离心后取血浆置于0℃贮藏室内，用液相色谱电化法测定NE和E含量。
1.4 统计学方法 测定结果采用SPSS 10.0软件包进行统计学处理，计量资料用均数±标准差(x±s)表示，组内比较用配对t检验。组间用两样本均数t检验。P<0.05表示差异有统计学意义。
2 结果
两组患者年龄、性别、体质量、病种、手术时间均无统计学差异(P>0.05)。观察期间SpO2 均大于96%，均未出现心律失常。A组SP、DP、MAP、HR阻滞前后各观察指标均有变化(P<0.05)，各时相(T2~T5)与其T1比较显著增高(P<0.01)。B组于T2~T4时较其T1增高(P<0.05)，但SP、DP、MAP、于T2~T5及HR于T4、T5时均显著低于A组(P<0.01) 血浆NE和E，A组阻滞后较阻滞前和B组间有变化(P<0.05)。, 百拇医药(颜道明 王开祥)