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目的探讨在稳定型心绞痛患者腹腔镜胆囊切除术中应用硝酸甘油、艾司洛尔,防治心肌缺血的发生。方法将60例患有稳定型心绞痛行腹腔镜胆囊切除术(LC术)患者随机分为硝酸甘油、艾司洛尔组(A组)及常规组(B组),观察EKG(HOLTER)、HR、血压及术前(T0)、术后6h(T1)、12h(T2)、24h(T3)心肌坏死标记物的变化。结果 A组各观察指标在T1、T2、T3对比T0差异无统计学意义(P>0.05)。B组术中HR增快、血压升高、ST段下移加深,对比术前差异有统计学意义(P<0.05)。在T1、T2、T3CTnI、CKMB比较T0及同时间A组CTnI、CKMB明显升高(P<0.01),且5例患者T1、T2、T3CTnI升高超过T010余倍,术后12hCTnI定性阳性。结论应用硝酸甘油、艾司洛尔控制HR、血压可改善心肌氧供及冠脉供血,防治稳定型心绞痛患者LC术中心肌缺血的发生发展。
Objective To investigate the application of nitroglycerin and esmolol in the treatment of patients with stable angina under laparoscopic cholecystectomy. Methods Sixty patients with stable angina underwent laparoscopic cholecystectomy (LC) were randomly divided into three groups: nitroglycerin, esmolol group (A) and conventional group (group B). EKG (HOLTER), HR , Blood pressure and preoperative (T0), postoperative 6h (T1), 12h (T2), 24h (T3) markers of myocardial necrosis. Results There was no significant difference in T0 between T1, T2 and T3 in observation group A (P> 0.05). In group B, the intraoperative HR increased rapidly, the blood pressure increased, and the ST segment decreased deeper. The difference was statistically significant (P <0.05). At T1, T2, T3CTnI and CKMB, CTnI and CKMB in group A were significantly higher than those in group T0 and group A at the same time (P <0.01). The T1, T2 and T3CTnI of T1, T2 and T3CT in group Ⅰ increased more than T010, and CTnI was qualitatively positive 12h after operation. Conclusion The application of nitroglycerin and esmolol to control HR and blood pressure can improve myocardial oxygen supply and coronary blood supply and prevent and treat the occurrence and development of LC myocardial ischemia in patients with stable angina pectoris.