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发行周期:
月刊
主管单位:
上海市卫生健康委员会
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上海市医学会
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ISSN:
ISSN0253-9934
CN:
CN31-1366/R
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1001255309008900719
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上海市医学会
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工商银行上海市静安寺支行
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尼卡地平和拉贝洛尔作为麻醉用药组分的可行性研究
The clinical investigation on feasibility of labetalol and nicardipine as a part of general anesthetics

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DOI:
作者:
陈蓓蕾
CHEN Beilei
作者单位:
上海交通大学附属瑞金医院麻醉科
Department of Anesthesiology，Ruijin Hospital，Shanghai Jiaotong University School of Medicine
关键词:
全身麻醉；尼卡地平；拉贝洛尔；地氟醚；脑电双频指数；苏醒
　　　general anesthesia; nicardipine; labetalol; desflurane; bispectral index; recovery
摘要:
摘 要 　　　目的 探讨在BIS监测下，以尼卡地平和拉贝洛尔替代部分镇静药和/或镇痛药的用量，来控制诱导插管及腹腔镜胆囊切除术中气腹和手术刺激引起的急性血流动力学改变，并在术后对用药组与对照组苏醒时间和质量进行比较，以期深入理解全麻本质的含义。 　　　方法 择期行腹腔镜胆囊切除术患者68例，ASAⅠ-Ⅱ级，年龄20-60岁，随机分为四组。以异丙酚2mg/kg、芬太尼2µg/kg和阿曲库胺0.6mg/kg诱导，并于气管插管前2分钟给以实验用药：Ⅰ组（对照组，16例，生理盐水2ml）、Ⅱ组（18例，拉贝洛尔2mg）、Ⅲ组（17例，尼卡地平1mg）和Ⅳ组（17例，尼卡地平0.5mg+拉贝洛尔1mg）。四组均在BIS监测下以地氟醚、芬太尼和阿曲库胺维持麻醉，Ⅱ、Ⅲ、Ⅳ组术中主要以实验用药控制应激反应，将平均动脉压和心率控制在基础值±20%以内的水平，并记录BIS值、诱导插管及术中血流动力学参数和呼气末地氟醚浓度。术毕比较各组苏醒时间和苏醒质量。 结果 实验组（Ⅱ、Ⅲ、Ⅳ组）与对照组（Ⅰ组）比较，均能减弱气管插管引起的心血管应激反应，联合用药组（Ⅳ组）在降压的同时能有效控制心率。拉贝洛尔和尼卡地平的应用可显著减少术中地氟醚的用量，实验组麻醉维持浓度（5.00±0.73、4.04±0.44、3.71±0.22%）与对照组（6.50±0.72%）比较，P<0.01。实验组（Ⅱ、Ⅲ、Ⅳ组）与对照组（Ⅰ组）比较，苏醒时间明显缩短（15.7±2.7、12.8±2.1、11.5±2.5 vs 18.3±2.4min）。术毕疼痛的发生率用尼卡地平的Ⅲ组和Ⅳ组（29%，24%）显著低于对照组（75%）。 　　　结论 拉贝洛尔和尼卡地平能有效抑制气管插管及腹腔镜胆囊切除术中气腹和手术刺激引起的心血管应激反应，显著减少术中地氟醚的用量。就本实验而言，尼卡地平的麻醉协同作用更明显。两药在减少地氟醚用量的同时并不增加术中知晓的风险；同时缩短了苏醒时间，提高了苏醒质量。术中尼卡地平的应用还可减少术后疼痛的发生率，降低术后阿片类药物的需求，有协同镇痛的作用。 关键词： 全身麻醉；尼卡地平；拉贝洛尔；地氟醚；脑电双频指数；苏醒
Abstract 　　　Objective To test the hypothesis that nicardipine and labetalol can maintain hemodynamic stability by replacing parts of the volatile anesthetic and opioid analgesics and depth of anesthesia was monitored by BIS during laparoscopic cholecystectomy under general anesthesia, and also to compare the recovery process between experiment groups and the control group, so that could we understand the essence of anesthesia . Methods Sixty-eight patients (20-60ys, ASAⅠ-Ⅱ), undergoing elective laparoscopic cholecystectomy, were randomly assigned to four groups: GroupⅠ(control,NS 2ml, n=16) varied the end-tidal concentrations of desflurane to maintain hemodynamic stability, not received any sympatholytic drugs. Group Ⅱ(labetalol 2mg, n=18), Group Ⅲ(nicardipine 1mg, n=18) and Group Ⅳ(labetalol 1mg + nicardipine 0.5mg, n=18) suppressed nociceptive stimuli mainly by the two sympatholytic drugs. During surgery, the mean arterial blood pressure (MAP) was maintained within ±20% of the baseline value. In addition to MAP and HR, the end-tidal concentrations of desflurane and BIS values were recorded throughout the anesthesia period. Recovery times and qualities were assessed. 　　　Results Compared with the control group,adjunctive use of labetalol and nicardipine attenuated the increase in HR (in Group Ⅱ) and MAP (in Group Ⅲ) after tracheal intubation.In Group Ⅳ,the combination of the two drugs controlled the hemodynamic changes effectively at the same time. The use of labetalol and nicardipine as an adjunct to desflurane reduced the end-tidal concentrations of desflurane. The anesthetic concentrations of experiment groups (5.00±0.73, 4.04±0.44, 3.71±0.22%，respectively) were significantly lower than that of the control group（6.50±0.72%）, P<0.01. Compared with the control group, the use of labetalol and nicardipine shortened the emergence times（15.7±2.7, 12.8±2.1, 11.5±2.5 vs 18.3±2.4min）;reduced the occurrence of pain after surgery in nicardipine groups (29%，24% vs 75%). 　　　Conclusion The adjunctive use of labetalol and nicardipine as a part of anesthetics during laparoscopic cholecystectomy attenuated the hemodynamic response to tracheal intubation ,pneumo-peritoneul and surgical stimuli. Furthermore, the use of labetalol and nicardipine reduced the end-tidal concentrations of desflurane. As much as this study shows, nicardipine’s anesthetic-sparing action is more significant. Use of labetalol and nicardipine as an adjuvant to desflurane anesthesia does not increase the risk of awareness, and also shorten the recovery times. Nicardipine’s analgesic-sparing action decreases the occurrence of pain and the requirement of opioids after surgery. 　　　Key words: general anesthesia; nicardipine; labetalol; desflurane; bispectral index; recovery

 

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