Protective Effect Of Combining Nitroglycerin With Esmolol On Myocardium Of Hypertensive Cerebral Hemorrhage Patients

The disease itself and operative stress responses of the hyperte- nsive cerebral hemorrhage should also have very serious attack to other important life organs of patients, heart is the one which implica- tes most easily. The most frequent appearance is myocardial ischemia. This kind of brain- heart relative change called brain-heart syndrome. The general concept of brain -heart syndrome is that the nerve -body fluid regulating function disorder which ori- ginated by brain disease causes the variance of heart physiological index,appearances corres- ponding symptoms and signs.This kind of patients often have poor prognosis and died of cardiac accident easily. Craniotomy is the most rapid and effective method to this disease, so it is very important to maintain steady of patient's vital sign and protect their myocardium.Purpose: To investigate the protective effect of combining nitroglycerin(NG)with esmolol(ESM) on myocardium in hypertensive cerebral hemorrhage patients undergoing craniotomy by measure the perioperative changes of the cardiac troponin-Ⅰ(cTnI)in serum, average artery blood pressure, heart rate, pulse oxygen saturation and the status of postoperative cardiac events.Methods: Twenty eight male hypertensive cerebral hemorrhage patients underwent craniotomy were randomly allocate to experim- ental group and control group with forteen cases each. Experimental group were injected ESM of 0.3mg/kg about one minute before incision,and then were persistently infused it by the speed of 0.03- 0.05mg/kg?min-1 and NG by the speed of 0.3-0.5μg/kg?min-1. Control group were injected sodium chloride of the same volume and speed with experimental group. Both groups were stopped infusions about ten minutes before operation ending. The perio- perative average artery blood pressure,heart rate and pulse oxygen saturation at the time of pre-anesthesia, 1 minute before infusions, 10 and 60 minutes after infusions and operation ending were recorded. Blood samples were obtained and collected in tubes before skin incision, 4h, 24h and 72h after skin incision. After centrifugation serum samples were kept -20℃until assayed. The levels of cTnI serum were measured by Dimension?clinical chemistry system. Heart events of these patients were followed up for 3 months.Results: The groups were similar in age,body weight, duration of surgery and perioperative transfusion of fluid.①There was no significantly difference between groupⅠand groupⅡin SpO2 at every time point.②The HR and MAP at pre-anesthesia, 1 minute before infusions and operation ending had no significantly difference between groupⅠand groupⅡ, but they at 10 and 60 minutes after infusions in groupⅠwere significantly lower than groupⅡ. In groupⅠ, MAP was significantly lower than 1 minute before infusions at 60 minutes after infusions; HR was significantly lower than 1 minute before infusions at 10 and 60 minutes after infusions.In groupⅡ, There were no significantly difference in HR and MAP compared 1 minute before infusions with every time point after infusions.③In both groups,the serum levels of cTnI had increased at 4h after skin incision,then reached the peak at 24h after skin incision,but slightly decreased at 72h after skin incision; And they before skin incision and 4h after skin incision had no significantly difference between groupⅠand groupⅡ,but they at 24h and 72h after skin incision in groupⅠw ere significantly lower than groupⅡ. In groupⅠ, the serum levels of cTnI was significantly higher than before skin incision at 4h and 24h after skin incision, but there was no significantly difference in the serum levels of cTnI compared before skin incision with 72h after skin incision.In groupⅡ, there were significantly difference in the serum levels of cTnI compared before skin incision with every time point after skin incision.④There was no significantly difference between groupⅠand groupⅡin the status of postoperative cardiac events.Conclusion:Although combining NG with ESM in hyperten- sive cerebral hemorrhage patients undergoing craniotomy can't inhibit myocardial damage and markedly reduce the status of postoperative cardiac events, but can control intraoprative blood pressure well, relieve cardiac preload and afterload, decrease cardiac work, depress myocardial oxygen consumption, improve myocardial blood flow,increase myocardial oxygen delivery, protect myocardium early. Therefore, combining NG with ESM perfect refer to undergo craniotomy of hypertensive cerebral hemorrhage patients, deserving generalization.