鼻内镜手术患者异丙酚复合瑞芬太尼控制性降压的可行性  

Controlled hypotension with remifentanil and propofol during endoscopic nasal sinus surgery

作　　者：王雪芹[1] 公文华[1] 周长青[1] 王焕亮[1] 张丽[1] 

机构地区：[1]山东大学齐鲁医院第二麻醉科,济南市250012

出　　处：《中华麻醉学杂志》2007年第1期36-38,共3页Chinese Journal of Anesthesiology

摘　　要：目的 探讨鼻内镜手术患者异丙酚复合瑞芬太尼控制性降压的可行性。方法 择期行鼻内镜手术患者30例，ASAI或Ⅱ级，随机分为2组（n=15）：对照组（Ⅰ组）和降压组（Ⅱ组）。两组均采用静脉注射咪达唑仑、异丙酚、瑞芬太尼和维库溴铵麻醉诱导，持续输注异丙酚和瑞芬太尼、间断静脉注射维库溴铵麻醉维持。桡动脉穿刺置管监测有创动脉血压（MAP）。Ⅰ组不施行控制性降压，Ⅱ组于手术开始时降压，瑞芬太尼初始速率为0．25μg·kg^-1·min^-1，每隔2分钟增加0．1μg·kg^-1·min^-1，直到降至靶目标血压，维持MAP50—70mmHg至手术结束。分别记录控制性降压开始即刻（T0）、30min（T1）和停止降压20min（T2）的HR、MAP，并于各时点抽桡动脉血行血气分析和乳酸测定。用评分法评定术野的质量。结果 与Ⅰ组相比，Ⅱ组手术时间缩短（P〈0．05），术野质量提高（P〈0．05）。控制性降压过程中瑞芬太尼的输注速率为（0．40±0．18）μg·kg^-1·min^-1，从降压开始到达靶目标血压所需时间为（6．5±2．3）min。与Ⅰ组相比，Ⅱ组T1时HR、MAP降低（P〈0．05）；与T0相比，Ⅱ组T1时HR、MAP降低（P〈0．05）。两组各时点的血气分析结果和乳酸浓度差异无统计学意义（P〉0．05）。两组均无心血管不良事件发生。结论 异丙酚复合瑞芬太尼用于鼻内镜手术患者控制性降压安全、有效。Objective To determine whether remifentanil combined with propofol could induce and sustain controlled hypotension during endoscopic nasal sinus surgery and to evaluate the safety and controllability. Methods Thirty ASA Ⅰ or Ⅱ patients （21 males, 9 females） aged 18-50 yrs weighing 45-85 kg undergoing endoscopic nasal sinus surgery were randomly divided into 2 groups （ n = 15 each） ： group Ⅰ control and group Ⅱ controlled hypotension. Anesthesia was induced with midazolam, propofol, remifentanil and vecuronium and maintained with continuous infusion of propofol and remifentanil. Radial artery was cannulated for direct and continuous MAP monitoring and arterial blood sampling （for determination of lactate concentration and blood gas analysis ） . Hypotension was induced at the beginning of removing process in group 11 . Remifentanil was infused at a rate of 0.25-0.5 μg·kg^-1·min^-1 until the target MAP （50-70 mm Hg） was reached and MAP was maintained at this level during operation. The blood loss from and dryness of the surgical field were evaluated and rated by the attending surgeon who was unaware of which group his patient belonged to. Rcsulls There was no significant difference in demographic data between the 2 groups. The duration of operation was significantly shorter in group 11 than in group I （control group）. The infusion rate of remifentanil during controlled hypotension was （0.40 ± 0.18）μg·kg^-1·min^-1 .Controlled hypotension was induced within （6.5 ± 2.3） min. MAP and HR were significantly lower in greup Ⅱ than in group Ⅰ （P 〈 0.05）. There was no significant difference in blood gases and lactate between the two greups.Conclusion Remifentanil combined with propofol can be used to induce and sustain controlled hypotension during endoscopic nasal sinus surgery.

关 键 词：二异丙酚 哌啶类 降压 控制性 内窥镜检查 可行性研究 

分 类 号：R686[医药卫生—骨科学]