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目的:观察硝酸甘油联合艾司洛尔控制性降压技术应用于颌面部骨折复位内固定术中的可行性。方法:选择96例颌面部骨折行骨折复位内固定术的患者,随机分为对照组(A组)、硝酸甘油降压组(B组)及硝酸甘油复合艾司洛尔降压组(C组),每组各32例。结果:B组诱导后的平均动脉压(MAP)较诱导前明显降低,而心率(HR)则明显增快,HR与收缩压(SBP)的乘积(RPP)增加;C组诱导后的MAP、HR及RPP比诱导前均明显下降,B、C两组诱导后的MAP比较,差异无统计学意义(P>0.05),但与A组比较,差异显著(P<0.01)。A、B两组诱导后的HR及RPP均明显升高,但两组比较,差异无统计学意义(P>0.05),C组诱导后的HR及RPP明显下降,与A、B两组比较,差异显著(P<0.01)。B、C两组术中血量及尿量与A组比较差异显著(P<0.01),C组出血量及硝酸甘油用药量明显低于B组(P<0.01)。3组术后均未见明显心脑栓塞等并发症发生。结论:硝酸甘油复合艾司洛尔控制性降压技术可安全有效地应用于颌面部骨折复位内固定术中。
Objective: To observe the feasibility of nitroglycerin combined with esmolol controlled hypotensive technique in maxillofacial fractures reduction and internal fixation. Methods: Ninety-six patients with maxillofacial fractures undergoing fracture reduction and internal fixation were randomly divided into control group (A group), nitroglycerin lowering group (B group) and nitroglycerin combined with esmolol hypotensive group (C Group), 32 cases in each group. Results: The mean arterial pressure (MAP) after induction in group B was significantly lower than that before induction, while the heart rate (HR) was significantly increased and the product of HR and systolic blood pressure (SBP) increased (RPP) HR and RPP decreased significantly compared with that before induction. There was no significant difference in MAP between B and C after induction (P> 0.05), but there was significant difference between A and B (P <0.01). HR and RPP were significantly increased in groups A and B after induction, but there was no significant difference between the two groups (P> 0.05). HR and RPP in group C were significantly decreased compared with groups A and B , Significant difference (P <0.01). The blood volume and urine volume in group B and C were significantly different from those in group A (P <0.01). The amount of bleeding and the dosage of nitroglycerin in group C were significantly lower than those in group B (P <0.01). No obvious complications such as cardiovascular and cerebrovascular embolism occurred in the three groups after operation. CONCLUSION: Nitroglycerin combined with esmolol controlled hypotensive technique can be safely and effectively applied in maxillofacial fractures reduction and internal fixation.