The Clinical Research Of Nicardipine And Esmolol Combined Used In Laparoscope To Control Stress

In recent decade, laparascopy has been used more and more widely inclinic due to its less injury, less pain and quicker recovery. On the otherhand,people have noticed that the stress reaction which is led bypeumoperitonum in circulation, respiration, endocrine and immune systems.Now CO2 is very commonly used in artificial peumoperitonum. It isinjected into abdominal cavity to support the abdominal wall, so as to providebroader space for operationers and not to hurt organs. When sympatheticnerve and RAS system are activated because of absorption of CO2 into bloodthrough peritoneum and increase of intraperitoneal pressure, the heart rate,systolic pressure and diastolic pressure increase significantly. Then the oxygenamount that the heart consuming and desiring increases. Although this istemporary, for the patients who has potential cardiac disease and bad cardiacfunction, the rise of blood pressure would lead to myocardial ischemia,arrhythmia even infarction. The common way to minimize the harm that thepneumoperitoneum brings is to deepen anesthesia. But it usually does notwork immediately before pneumoperitoneum, further more it is hard tocontrol heart rate and tachycardia, circulation depress revival delay areinclined to happen.The main task of this experiment was to stabilize the hemodynamics andreduce stress reaction in laparoscopy by observing blood pressure, blood sugarand urine volume as parameters of stress reaction, and the effect to blood gasand gaspipe resistance by combining nicardipine and esmolol together.Forty ASAⅠ~Ⅱ patients who would undergo selective laparoscopiccholecystectomy were selected and they had not hypertension, diabetesmellitus, tachycardia, atrioventricular block, asthma or taking β-receptorblocker and calcium channel blocker before operation 24 hours.These paitentswere divided into two groups. GroupⅠwas for contrast, groupⅡ wasexperimentive. There were no difference in age, gender or weight. Scoplamine0.3mg was injected IM before anesthesia 30 minutes. After venous passwaywas conducted, Ringer's salution were supplied rapidly 10ml/kg. Anesthesiawas induced with midazolam 0.1mg/kg, vencuronium 0.1mg/kg, fentanyl3μg/kg and propoful 1.5mg/kg. After intubation was performed,Datex-Ohmeda 7000 anesthesic device was connected for mechanicalventilation. The tidal volume was set 10ml/kg, respiration rate was set 15/minand I:E was set 1:2. 1%~2% isoflurane was used for anesthesia maintenance.All patients were monitored by UP-8000 multi-parameter monitor, CSI 40~60maintained, vencuronium 2~4mg injected intermittently. Keep ahead-up-foot-low position with the angle 15o~20o and the intraperitonealpressure was set 12mmHg. Esmolol 100mg and nicardipine 1mg were mixedinto 20ml, 0.2ml/kg was injected during pneumoperitoneum, 5 minutes laterthe mixture was pumped at 0.2~0.4ml/kg/h until the end ofpneumoperitoneum. The same amount of saline was injected at the samespeed in Group Ⅰ. The standard for extubation was conscious, able to keephead up for 5s and SpO2 more than 95% with air. Parameters to observe: ①ECG, HR, NIBP, SpO2.② maintain CSI 40~60 during operation.③ recordSBP,DBP,MAP,SpO2 ,Paw ,blood gas,blood sugar and calculate RPP .Statisticanalysis: All data were shown in the form of x ±s and analyzed by SPSS softthrought test, statistic deviation existed when P < 0.05.Result: ① Thecomparision of general documents was no significant deviation(P>0.05).②The blood gas was no significant deviation at any time for either group(P>0.05). ③ The hemodynamics indexes increased significantly afterpneumoperitonum in group Ⅰ.However these indexes did not increaseobviously in group Ⅱ.④ In group Ⅰ blood sugar increased obviously afterpneumoperitonum but it did not happen in group Ⅱ. Significant deviationexisted in blood sugar and urine volume after operatiom for both groups(P<0.05).Pneumoperitoneum was important for the performance of laparoscopy toprovide a clear operating space. However once certain gas was injected intoperitoneum, it caused mechanical pressure to organs and diaphragm and aseries of stress reactions. In this experiment, blood sugar and urine volumewere chosen to observe the effect of combing nicardipine and esmololtogether to control pneumoperitoneum stress.Esmolol was a super selective short-term β 1 receptor blocker.Nicardipine was a calcium-channel blocker which could distense coronalartery to protect heart muscle. It could increase cardiac muscle strength andinput and reduce the depress that esmolol brought. On the other hand, esmololcontrolled heart rate well due to its rapid β receptor blocking so that itfulfilled the reactive tachycardia that nicardipine brought. Therefore, thecombination of nicardipine and esmolol was an ideal method for stablehemodynamics in operation.Through this experiment we could get the conclusion as follows:①Combination of nicardipine and esmolol in laparoscopy had no bad effect onblood gas and Paw.② The two medicines could be effective in keeping stablehemodynamics without obvious hypotension and bradycardia.③ Analysis ofblood sugar and urine volume reflected that combination of nicardipine andesmolol in laparoscopy could control the stress pneumoperitoneum brought.