急性高容量血液稀释复合瑞芬太尼与硝酸甘油控制性降压在脊柱手术中应用的比较研究  

Comparative study of aapplication of aacute hypervolemic hemodilution of remifentanil or nitroglycerin to control blood pressure in spinal surgery

作　　者：侯明勇[1] 魏江涛[1] 何斌[1] 陈勇[1] 王两中 罗燕[1] 董理[1] 

机构地区：[1]成都铁路中心医院麻醉科,成都市610081

出　　处：《临床合理用药杂志》2009年第12期28-30,共3页Chinese Journal of Clinical Rational Drug Use

摘　　要：目的比较琥珀酰明胶急性高容量血液稀释(AHH)复合瑞芬太尼与硝酸甘油控制性降压在脊柱手术中应用的效果及其安全性。方法将26例ASAⅠ～Ⅱ级腰椎爆裂骨折行椎弓根螺钉内固定手术患者随机分为观察组和对照组,各13例。2组切皮前按15ml/kg,50ml/min静脉内快速输注琥珀酰明胶行AHH。观察组以瑞芬太尼0.2μg/kg静脉注射,0.05～0.5μg.kg-1.min-1维持。对照组以硝酸甘油2μg/kg静脉注射,0.5～3μg.kg-1.min-1维持。平均动脉压(MAP)维持在60～65mm Hg(1mm Hg=0.133kPa),至手术骨质操作完成。观测AHH前、AHH后降压前、停止降压即刻、手术结束时动脉血凝(APTT、PT)、MAP、中心静脉压(CVP)、失血量及清醒拔管时间。结果2组AHH后降压前、停止降压即刻及手术结束时APTT和PT与AHH前比较无差异(P>0.05);控制降压期间观察组的心率(HR)显著低于降压前(P<0.05),而对照组高于降压前(P<0.05),对照组CVP显著低于降压前(P<0.05),观察组与降压前相比无差异(P>0.05);观察组失血量明显少于对照组(P<0.01)。患者清醒拔管时间2组无差异(P>0.05)。结论琥珀酰明胶AHH复合瑞芬太尼降压用于脊柱手术安全有效。与硝酸甘油相比,瑞芬太尼控制性降压具有减慢心率、降压平稳、对中心静脉压影响小、失血量少等优点。Objective To compare the efficacy and safety of acute hypervolemic hemodilution （AHH） of remifentanil or nitroglycerin with succinylated gelatin in spinal surgery. Methods Twenty six with ASA I - H lumbar burst fractures who were performed internal fixation of pedicle screw were randomatieally divided into remifentanil group（R） （n = 13 ） and nitro- glycerin group（N） （n = 13）. sueeinylated gelatin was administrated intravenously with a velovity 15ml/kg, 50ml/min to give an acute hypervolemic hemodilution in each group. Remifentanil was gave intravenously with a velovity of 0. 05 - 0.5μg/kg/ min in R group and nitroglycerin with 0.5 -3μg/kg/min in N group. The MAP （ mean artery pressure） was maintained 60-65mmHg until the end of operatin bone substance. The artery coagulation, MAP, CVP, blood loss and time of conscious extu- bation were detected before AHH, after AHH before depressing blood pressure, the time of slopping depressing blood pressure and the time which the operation was over. Results After AHH, APTT and PT were not different in each group （ P 〉 0.05 ）. HR during control depressing pressure was lower than before depressing blood pressure in R group（ P 〈 0.05 ） , but was higher in N group（ P 〈0.05 ）. CVP during control depressing pressure was lower than before depression blood pressure in R group （P〈0.05）, but not difference in N group（P 〉0.05）. The volume of blood loss of R goup was significant less than that of N group （P 〈0.01 ）. The time of conscious extubation was no difference between the two groups （ P 〉 0.05 ）. Conclusion AHH of remifentanil with succinylated gelatin to control depressing blood pressure can be used safety and effectively in spinal surgery. Compared with nitroglycerin, control depressing blood pressure with remifentanil have the following benefits： slowing HR,depressing blood pressure placidly,less influencing CVP,less blood loss.

关 键 词：急性高容量血液稀释 琥珀酰明胶 瑞芬太尼 硝酸甘油 控制性降压 

分 类 号：R614[医药卫生—麻醉学]