鼻内镜手术中美托洛尔辅助瑞芬太尼控制性降压的效果  

Effect of remifentanil controlled hypotension with metoprolol-assisted during endoscopic sinus surgery

作　　者：陈锐[1] 周期[1] 王春莲[1] 

机构地区：[1]海南医学院附属医院麻醉科,海口570102

出　　处：《重庆医学》2011年第6期581-582,584,共3页Chongqing medicine

摘　　要：目的探讨鼻内镜手术中美托洛尔辅助瑞芬太尼行控制性降压的效果。方法 40例择期行鼻内镜手术患者,随机分为对照组(Ⅰ组)和实验组(Ⅱ组)。两组均采用靶控输注瑞芬太尼、异丙酚及吸入异氟醚进行控制性降压。Ⅱ组加用美托洛尔控制心率。记录控制性降压开始时(T1)、手术切开鼻黏膜时(T2)、控制性降压30 min后(T3)、手术结束时(T4)和停止降压20 min(T5)时的心率、平均动脉压(MAP)、血乳酸浓度及pH值。记录达到目标血压的时间和瑞芬太尼的血浆靶浓度。结果Ⅰ组患者中有4例未能达到目标血压,Ⅱ组患者全部达到目标血压。Ⅱ组达到目标血压时的时间比Ⅰ组短,瑞芬太尼的靶浓度较Ⅰ组低(P<0.05)。Ⅰ组和Ⅱ组患者血乳酸浓度在T3和T5时均较T1时高(P<0.05),Ⅱ组患者血乳酸浓度在T5时比Ⅰ组低(P<0.05)。结论鼻内镜手术中美托洛尔辅助瑞芬太尼控制性降压,起效快、过程平稳、可控性强、恢复迅速。Objective To evaluate effect of remifentanil controlled hypotension with metoprolol-assisted during endoscopic sinus surgery.Methods 40 cases underwent endoscopic sinus surgery were randomly divided into control group（group Ⅰ） and experiment group（groupⅡ）.Both groups used target-controlled infusion of remifentanil,propofol and isoflurane inhalation for controlled hypotension.Metoprolol was added to control heart rate in group Ⅱ.The MAP,heart rate,plasma lactate concentration and pH were recorded at beginning of control hypotension（T1）,the incision of endoscopic sinus surgery（T2）,controlled hypotension 30 min（T3）,the end of surgery（T4） and stop controlling hypotension 20 min（T5）.Recording remifentanil target concentration and time to achieve target blood pressure.Results 4 cases of 20 patients failed to achieve target blood pressure in group Ⅰ,all patients in group Ⅱachieved target blood pressure.The time of reaching the target blood pressure in group Ⅱwere shorter than that in group Ⅰ,the remifentanil target concentration in group Ⅱ were lower than in group Ⅰ（P0.05）.Blood lactic acid concentration of T3 and T5 time point were higher than those of T1 In group Ⅰ and group Ⅱ（P0.05）,the blood lactate concentration of group Ⅱ were lower than those of group Ⅰ at T5 time point（P0.05）.Conclusion Remifentanil controlled hypotension with metoprolol-assisted during endoscopic sinus surgery,showing rapid onset,the process smooth,controlled easy and speedy recovery.

关 键 词：瑞芬太尼 美托洛尔 控制性降压 鼻内镜手术 

分 类 号：R614[医药卫生—麻醉学]