2018 年第 1 期 第 13 卷

硝酸甘油和艾司洛尔在老年冠状动脉粥样硬化性心脏病患者非心脏手术全身麻醉中的应用价值

作者：张可心任发成

英文作者：

单位：100029首都医科大学附属北京安贞医院麻醉科

英文单位：

关键词：冠状动脉粥样硬化性心脏病；全身麻醉；硝酸甘油；艾司洛尔

英文关键词：

• 摘要：

• 【摘要】目的    探讨硝酸甘油和艾司洛尔在老年冠状动脉粥样硬化性心脏病（冠心病）患者非心脏手术全身麻醉中的应用价值。方法    选取2016年6月至2017年6月于首都医科大学附属北京安贞医院接受非心脏手术的老年冠心病患者80例。根据随机数字表法将患者分为观察组与对照组，各40例。所有患者均在全身麻醉下进行非心脏手术治疗，对照组患者在麻醉诱导前不应用任何药物干预，观察组在麻醉诱导前静脉泵注硝酸甘油与艾司洛尔。比较2组患者围术期各时点心率和平均动脉压（MAP）情况及不良反应情况。结果    观察组患者麻醉诱导后、气管内插管时、切皮时、手术结束时心率和MAP均明显低于麻醉诱导前［(83±11)、（84±8）、（91±8）、（82±8）次/min比（105±16）次/min；（90±8）、（93±7）、（99±8）、（88±8）mmHg(1 mmHg=0.133 kPa)比（107±12）mmHg］，且均明显低于对照组［(96±10)、（95±11）、（96±11）、（98±18）次/min；（100±11）、（103±14）、（106±13）、（103±12）mmHg］(均P<0.05)。2组不良反应发生率差异无统计学意义（P＞0.05）。结论    在老年冠心病非心脏手术全身麻醉中应用硝酸甘油与艾司洛尔能够有效控制患者心率与血压变化情况，对稳定血流动力学，保证手术顺利进行、减轻患者术中心功能损害具有重要意义。

• Application of nitroglycerin and esmolol during general anesthesia of noncardiac surgery in elderly patients with coronary atherosclerotic heart disease

  Zhang Kexin, Ren Facheng

  Department of Anesthesiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China

  Corresponding author: Ren Facheng, Email: renfacheng2008@sina.com

  【Abstract】Objective     To investigate the application value of nitroglycerin and esmolol during general anesthesia of noncardiac surgery in elderly patients with coronary atherosclerotic heart disease（CHD）. Methods    Totally 80 elderly patients with CHD undergoing noncardiac surgery from June 2016 to June 2017 in Beijing Anzhen Hospital, Capital Medical University were randomly divided into observation group and control group, with 40 cases in each group. The control group had no special drug treatment before induction of general anesthesia; the observation group had intravenous administration of nitroglycerin and esmolol before anesthesia induction. Changes of heart rate（HR） and mean arterial pressure（MAP） during perioperative period and occurrence of adverse reactions were analyzed. Results    HR and MAP after anesthesia induction, at the time of endotracheal intubation, skin incision and the end of operation were significantly lower than those before anesthesia induction in observation group［(83±11),（84±8）,（91±8）,（82±8）times/min vs（105±16）times/min; （90±8）,（93±7）,（99±8）,（88±8）mmHg vs（107±12）mmHg］(P<0.05); HR and MAP after anesthesia induction, at the time of endotracheal intubation, skin incision and the end of operation in observation group were significantly lower than those in control group［(96±10),（95±11）,（96±11）,（98±18）times/min; （100±11）,（103±14）,（106±13）,（103±12）mmHg］(P<0.05). There was no significant difference of incidence of adverse reactions between groups(P>0.05). Conclusion    Nitroglycerin and esmolol can effectively stabilize changes of HR and MAP during noncardiac and reduce cardiac damage in elderly patients with CHD.

  【Key words】Coronary atherosclerotic heart disease;General anesthesia;Nitroglycerin;Esmolol