Antihypertensive therapy and prevent coronary disease / 中国实用内科杂志

For hypertension,lowering blood pressure is the basis and well controlled pressure is the core.The ultimate goal of the therapy is to decrease the risk of target organs damage,then minimize the occurrence of cardiovascular endpoint events.Evidence based medicine has confirmed the advantage of ACEI and CCB therapy in controlling blood pressure,lowering the incidence and the mortality of coronary disease.

Influence of the controlled hypotension induced by nicardipine combined with low dose esmolol on blood catecholamine, beta2-microglobulin and lactate / 中华麻醉学杂志

Objective To investigate the feasibility of inducing controlled hypotension (CH) with nicardipine and low dose esmolol and its influence on blood catecholamine, blood beta 2-microlobulin (?2-mG) and tissue aerobic metabolism. Methods Thirty patients undergoing elective surgery for bone tumor were randomly divided into 3 groups: control group (C, n = 10); nicardipine group (N, n = 10) and nicardipine + esmolol group (N + E, n= 10). Controlled hypotension (CH) was started 15 min after incision. In group N nicardipine was infused at 2.5?g?kg-1?min-1 initially and in group N + E nicardipine (2.5?g?kg-1?min-1 ) and esmolol (12. 5?g?kg-1?min-1) were infused initially. When MAP was reduced to 60-70mm Hg nicardipine infusion rate was adjusted to maintain MAP at this level in both groups. In control group no CH was induced. The patients were premedicated with pethidine 25-50mg and scopolamine 0.3?g im. Anesthesia was induced with fentanyl 3?g?kg-1, propofol 1.2-2.5mg?kg-1 and vecuronium 0. 12mg?kg-1 iv and maintained with isoflurane inhalation (end-tidal concentration 1.0%-2.0%) and intermittent iv boluses of vecuronium . Radial artery was cannulated for continuous BP monitoring and internal jugular vein was cannulated for CVP monitoring. ECG , SpO2 and end-tidal CO2 concentration were continuously monitored . Blood samples were taken before CH (T0) , when MAP was reduced to 60-70mm Hg (T1), 30 min after CH had been maintained for 30min(T2 ), at the end of CH (T3) and at the end of operation (T4 ) for determination of concentrations of catecholamine ,?2-mG , lactate and Hb. Results The demographic data including age, body weight and height were comparable among the three groups. There was no significant difference in preoperative Hb and ALT, AST, Cr andBUN levels. There was also no significant difference in the duration of CH between group N and group N + E . In group C and N norepinephrine (NE) level gradually increased during CH whereas in group N + E NE level increased only slightly during CH as compared with the baseline value (T0) , and was maintained at this low level.?2-mG level was not significantly elevated during CH but lactate level increased significantly during CH in all three groups . There was no significant difference in urine output during CH among the three groups. Conclusion Hypotension with nicardipine does not result in tissue anaerobic metabolism and renal damage. Its combination with low dose esmolol has stress-inhibiting effect.

The feasibility of acute hypervolemic hemodilution combined with controlled hypotension in patients undergoing elective orthopedic operations / 中华麻醉学杂志

Objective To investigate the effects of acute hypervolemie hemodilution(AHH)combinedwith bypotension(CH)on hemodynamies and tissue perfusion and to evaluate the safety of the technique.MethodsForty-eight ASA Ⅰ-Ⅱ patients of both sexes(28 male,20 female)aged 41-63 yr weighing 47-85kg undergoingelective orthopedic operations were randomly divided into 4 group with 12 patients in each group:A control group;B CH group;C AHH group and D CH+AHH group.The patients were premedicated with oral diazepam 10 mgand intramuscular atropine 0.5 mg.Anesthesia was induced with midazolam 0.04 mg?kg~(-1),fentanyl 4?g?kg~(-1),propefol 1.5-2.0 mg?kg~(-1) and vecuronium 0.1 mg?kg~(-1) and maintained with inhalation of 1%-3 % isoflurane and50% N_2O in O_2 supplemented with intermittent i.v.boluses of vecaronium.The patients were mechanicallyventilated after tracheal intubation(V_T=8-10 ml?kg~(-1),RR 12 bpm).Radial artery and right internal jugular veinwere cannulated.The CVP catheter was inserted into right atrium and the blood obtained from right atrium was usedto replace mixed venous blood.ECG,MAP,HR,CVP,SpO_2 and urine output were continuously monitored duringoperation.Controlled hypotension was induced with sodium nitroprusside(NTP)at 0.1-2 ?g?kg~(-1)?min~(-1) andMAP was maintained at 70% of the baseline MAP during operation.NTP infusion was terminated 30 min beforethe end of surgery.AHH was induced with 6% HES 15 ml?kg~(-1) at 50 ml?min~(-1) after induction of anesthesia andbefore skin incision.Blood samples were taken from radial artery and right atrium before AHH(T_0,baseline),immediately after AHH or before CH(T_1),1h after AHH or 40 min after start of CH(T_2),at the end of surgeryor 30 rain after termination of NTG infusion(T_3)and 24h after surgery(T_4)for blood gas analysis and calculationof oxygen extraction ratio(ERO_2).Blood volume was maintained with infusion of colloid and lactated Ringer'ssolution.The amount of blood loss and blood transfusion were recorded.Hb was maintained above 70 g?L~(-1)Results CVP increassd significantly after AHH in group C and D as compared to baseline(P0.05).Conclusion AHH combined with CH can maintain stable hemodynamics,decrease blood loss andblood transfusion during operation and maintain the balance between oxygen delivery and oxygen consumption.

Effects of nicardipine-induced hypotension on splanchnic perfusion in patient undergoing meningioma resection / 中华麻醉学杂志

Objective Controlled hypotension induced by different drugs may have different effects on splanchnic perfusion. The purpose of this study was to assess the effects of nicardipine- induced hypotension on splanchnic perfusion. Methods Twenty-three ASA Ⅰ-Ⅱ patients (14 male, 9 female) aged 21-60 yr undergoing meningioma resection were studied. The patients were premedicated with ranitidine 150 mg per os and atropine 0.5 mg i.m. Anesthesia was induced with propofol 1.5-2.0 mg?kg-1 , fentany1 2.0?g?kg-1 and vecuronium 0.1 mg? kg-1 and maintained with isoflurane inhalation and intermittent i. v. boluses of fentanyl and vecuronium. The patients were mechanically ventilated after tracheal intubation and PETCO2 was maintained at 33-35 mm Hg. Nicardipine-induced hypotension started from opening of mininges to the resection of tumor. 0.01% nicardipine infusion was started at 30 ml?h-1 and adjusted to reduce systolic blood pressure by 30% of the baseline or MAP to≥60 mm Hg. The adequacy of splanchnic perfusion was defined by gastric intramucosal CO2 tension (PgCO2), the intramucosal pH (pHi) and the difference between intramucosal and arterial PCO2(PCO2 gap) and was assessed before induction of anesthesia, the 1st, 2nd and 3rd hour during controlled hypotension and 1, 2 hour after termination of controlled hypotension. Results The MAP was maintained at about 62 mm Hg during controlled hypotension. The heart rate was stable. Hct was significantly decreased at 1st, 2nd and 3rd hour of hypotension compared with baseline but the mean Hct was greater than 30% . The intramucosal pH decreased slightly with no statistical significance and pHa, PaCO2 , PgCO2 and PCO2 gap were almost unchanged during controlled hypotension compared with the baseline values. Conclusion Nicardipine-induced hypotension is safe when MAP is maintained at≥60 mm Hg and has no adverse effects on splanchnic perfusion.