内窥镜下鼻手术应用瑞芬太尼控制性降压的研究  

A comparison of remifentanil with nicardipine for controlled hypotension during endoscopic nasal sinus surgery

作　　者：岳彬[1] 郝晓燕[1] 唐涛[1] 梁滨沈[1] 

机构地区：[1]辽宁省大连市友谊医院麻醉科,116001

出　　处：《中国实用医刊》2009年第11期15-16,共2页Chinese Journal of Practical Medicine

摘　　要：目的对比评价内窥镜下鼻手术应用瑞芬太尼或盐酸尼卡地平控制性降压麻醉的效果。方法30例ASAI～Ⅱ级择期行内窥镜下鼻手术病人，年龄15～63岁，随机分为瑞芬太尼组（R组）和盐酸尼卡地平（N组），每组15例。两组病人麻醉诱导及维持方法相同。R组以瑞芬太尼2μg/kg静注，0．1～0．5彬（kg·min）维持；N组以盐酸尼卡地平1μg/kg静注，0．5～1μg/（kg·min）维持。桡动脉穿刺直接动脉测压。两组均将平均动脉压（MAP）降至50～70mm Hg（1mm Hg=0．133kPa）至手术结束。观察两组病人术中平均动脉压、中心静脉压、心率变化、失血量的差异。结果降压期间R组的心率显著低于降压前（P〈0．01），而N组显著高于降压前（P〈0．05）。N组降压5、10、15min时中心静脉压显著低于降压前（P〈0．05），R组与降压前相比差异无统计学意义。结论瑞芬太尼可有效地用于内窥镜下鼻手术控制性降压；与盐酸尼卡地平相比，具有减慢心率、降压平稳、对中心静脉压影响小等优点。Objective To compare the effects of remitentanil and nlcardlplne for controlled nypotension during endoscopic nasal sinus surgery. Methods Thirty ASA I or II patients aged 15 -63 years undergoing endoscopic nasal sinus surgery were randomly divided into 2 groups（ n = 15 each） ： group R control and group N controlled hypotension. Anesthesia induction and maintenance in both groups were the same method. In group R, intravenous administration of remifentanil 2 μg/kg, followed by infusion of remifentanil 0.1 -0.5μg/（ kg · min） for controlled hypotension, and the patients of group N received nieardipine 1μg/kg, followed by nicardipine 0.5 - 1μg/（ kg · rain）. The target of controlled hypotension was fixed at MAP 50 - 70 mm Hg, which was maintained the end of surgery. The changes of MAP, CVP and HR in two groups were recorded during surgery. Results HR was significant reduced in R group compared with that before （ P 〈 0.01 ）, which was significant increased in N group during controlled hypotension （P 〈 0.05）. CVP value during 5 -15 min controlled hypotension was significantly lower than that before in group N （ P 〈 0.05） ,but not in group R. Conclusions Remifentail could be used effectively for controlled hypotension during endoscopic nasal sinus surgery with less influence on CVP.

关 键 词：瑞芬太尼 降压 控制性 内窥镜检查 

分 类 号：R614[医药卫生—麻醉学]