脊柱和髋关节手术中瑞芬太尼控制性降压效果分析  

Controlled hypotension effects of remifentanil combined with propofol and isoflurane during the surgery of spinal column and hip joint

作　　者：周艳梅[1] 焦文刚[2] 李庆华 李福仙[1] 

机构地区：[1]延边大学医学院附属医院麻醉科,吉林延吉133000 [2]杭州市第一人民医院,浙江杭州310006 [3]长春市公安边防总队医院,吉林长春130051

出　　处：《现代医药卫生》2008年第6期823-824,共2页Journal of Modern Medicine & Health

摘　　要：目的:探讨脊柱和髋关节手术的麻醉期间瑞芬太尼复合异丙酚的控制性降压效果。方法:40例骨科择期手术患者中,全髋关节置换术16例,胸腰椎骨折切开复位内固定术24例,均为ASAⅠ￣Ⅱ级,无心、肺、脑等重要脏器病变,随机分为两组,每组20例。R组为瑞芬太尼控制性降压治疗;N组为硝酸甘油控制性降压治疗。麻醉诱导后,以异丙酚靶控输注(TCI)2.0￣2.4μg/ml,恒异氟醚吸入浓度1%￣2%,通过调节瑞芬太尼或硝酸甘油的输注速度进行控制性降压,维持收缩压在80￣90mmHg、平均动脉压在55￣70mmHg,记录入室时(T0)、麻醉诱导后5min(T1)、降压前即刻(T2)、降压后5min(T3)、15min(T4)、复压后5min(T5)时的血压(BP)、心率(HR)、脉搏氧饱和度(SpO2)、心电(ECG)和脑电双频指数(BIS)等监测参数。结果:R组降压速度快且平稳,心率呈剂量依赖性下降,个别病例降至50次/min以下,经给予阿托品迅速回升,BIS值也随瑞芬太尼用量的增加而下降,复压时无反跳性高血压和反射性心动过速。结论:瑞芬太尼复合异丙酚行控制性降压给脊柱和髋关节手术可提供良好的手术条件,不需要特定的降压药物。Objective：To determine whether remifentanil combined with propofol could induce controlled hypotension during the anesthetic phase of spinal column and hip joint surgery.Methods：A total of 40 patients（ASA Ⅰ~Ⅱ） undergoing orthopedics surgery,including 16 cases of hipbone joint displacement,24 cases of thoracic lumbar vertebral fracture surgery, without pathological changes of important organs like heart,lung,brain etc,were divided into two groups （with 20 cases in each group） at random, namely remifentanil group （group R） and nitroglycerin group （group N）.After inducement of anesthesia,TCI of propofol（ 2.0~2.4 μg/ml） and inhalation of 1%~2% isoflurane were performed to maintain anesthesia during surgery.Remifentanil（0.2~0.5 μg/kg·min-1） was continuously transfused into the patients so as to maintain the systolic blood pressure （SBP） at 80~90 mmHg and MAP at 55~70mmHg in group R,while nitroglycerin was applied to group N.The haemodynamic features of BP,HR,SpO2 and other parameters,such as ECG,BIS were recorded respectively at different time points：entering into the operating room（T0）, 5 min after anesthesia inducement（T1）,time of hypotension（T2）,5min after hypotension（T3）,15 min after hypotension（T4）,and 5 min after recovering to normal BP（T5）.Results：In remifentanil group, velocity of hypotension was rapid and smooth,as well as heart rate decreased dose-dependently. In some special cases, HR was less than 50 times/min,however,it could return to normal level rapidly by injection of atropine. Likewise,the index of BIS decreased as the dosages of remifentanil increased. There was no rebound hypertension and reflecting tachycardia during recovery of blood pressure.Conclusion：Remifentanil combined with propofol enabled controlled hypotension,and provided good surgical conditions for spinal column and hip joint surgery with no need for additional use of a potent hypotensive agent.

关 键 词：瑞芬太尼 硝酸甘油 控制性降压 

分 类 号：R614[医药卫生—麻醉学]