| 摘要: |
| 目的 探讨艾司洛尔对服用ACEI类药物高血压患者麻醉诱导期血流动力学及QT间期和QTD的影响。方法 选择ASAI~II级有器质性高血压且规律服用ACEI类药物拟行择期手术患者60例，采用随机数字表法分为艾司洛尔组（E组）和对照组（C组），各30例。E组给艾司洛尔负荷量500滋g/kg，然后以100滋g/（kg·min）输注，诱导后4min停止输注。C组输注同样剂量的0.9%氯化钠溶液。艾司洛尔或0.9%氯化钠溶液输注5min后，给2mg/kg丙泊酚、1滋g/kg芬太尼、1mg/kg维库溴铵3min内完成气管插管。记录患者麻醉诱导前（T0）、艾司洛尔或0.9%氯化钠溶液输注后5min（T1）、诱导用药后3min（T2）、插管后30s（T3）、2min（T4）及4min（T5）的平均动脉压（MBP）、心率（HR）、QTc、QTcD；并观察患者的不良反应。结果两组患者T0时MBP、HR、QTc、QTcD比较差异无统计学意义（P＞0.05）。与C组比较，E组在T1~T3MBP均降低，E组T1~T5各时点的MBP及C组T2~T5各时点的MBP较T0时MBP均明显降低，差异均有统计学意义（均P＜0.05）。两组在T3HR变化相比较差异有统计学意义（P＜0.05）。E组除T3外，其余各时点HR均较T0降低，C组在T2时HR较T0减慢，而在T3较T0增快，差异均有统计学意义（均P＜0.05）。与C组比较，E组T3时QTc、QTcD明显缩短，差异有统计学意义（P＜0.05）。E组T1~T5各时点QTc间期、QTcD与T0时比较差异均无统计学意义（均P＞0.05）。C组T3、T4QTc、较T0、T1均延长，C组T2、T3、T4QTcD较T0均延长，差异均有统计学意义（均P＜0.05）。C组插管后4min心律失常发生率相对较高，差异有统计学意义（P＜0.05）。两组均无恶心、呕吐、咳嗽、尿潴留等不良反应。结论对服用ACEI类药物的高血压患者，艾司洛尔可以抑制麻醉诱导时血流动力学指标波动并缩短延长的QTc及QTcD。 |
| 关键词: ACEI 类药物 高血压 艾司洛尔 QTc QTcD |
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| Effect of esmolol on QTc and QTcD during anesthesia induction in hypertensive patients with medication of ACEIs |
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YANG Huifang, SUN Jianliang, JIN Qianqian, XI Jianhua
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Hangzhou First People's Hospital
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| Abstract: |
| Objective To investigated the effect of esmolol on QTc and QTcD during anesthesia induction in hyper- tensive patients with medication of angiotensin converting enzyme inhibitors (ACEIs). Methods Sixty ASA I~II patients, with essential hypertension using ACEIs undergoing selective operation were randomly allocated to two groups with 30 in each. Pa- tients in group E received esmolol at a bolus dose of 500滋g/kg followed by a 100滋g/ (kg•min) infusion which continued until 4min after intubation. patients in group C received 0.9% saline instead of esmolol. The mean blood pressure(MBP), heart rate(HR), QTc, QTcD were recorded before induction of anesthesia (T0), 5 min after application of esmolol or 0.9% saline (T1), 3 min after induc- tion(T2), 0.5min, 2 min and 4 min after intubation (T3~T5). Adverse reactions were also observed. Results There were no signifi- cant differences in patients characteristics and MBP, HR, QTc, QTcD at T0. Compared with group C, MBP was decreased in
group E at T1~T3 (P＜0.05). Compared with MBP at T0, MBP was significantly decreased at T1~T5 in group E and at T2~T5 in group
C. There were statistical differences of HR at T3 between two groups (P＜0.05). Compared with HR at T0, HR of group E in all time points were decreased except T3 (P＜0.05). HR of group C was decreased at T2, while that was increased at T3 (P＜0.05). Com- pared with group C, QTc and QTcD were shorter in group E at T3 (P＜0.05). There was no significant difference in QTc and QTcD in group E between baseline and other time points (P ＞0.05). The QTc was longer in group C at T3~T4 (P＜0.05), and QTcD was longer in group C at T2~T4(P＜0.05). The risk of arrhythmia frequency was higher in group C in the 4-min period following intuba- tion with statistical differences. No patients developed other adverse reactions. Conclusion Esmolol can prevent instable hemo- dynamics and prolonged QTc and QTcD during anesthesia intubation in hypertensive patients with medication of ACEIs. |
| Key words: ACEIs Hypertensive patients Esmolol QTc QTcD |
