不同血浆靶浓度瑞芬太尼对鼻内镜手术患者鼻黏膜微循环的影响  

Effects of different target plasma concentrations of remifentanil on nasal mucosal blood flow during endoscopic nasal sinus surgery

作　　者：孙梅杰[1] 边雯[1] 李刚[2] 时光刚[3] 

机构地区：[1]山东大学附属省立医院西院麻醉科,济南市250022 [2]山东大学附属省立医院ICU,济南市250022 [3]山东大学附属省立医院耳鼻喉科,济南市250022

出　　处：《临床麻醉学杂志》2011年第2期119-122,共4页Journal of Clinical Anesthesiology

基　　金：山东省自然科学基金项目(Y2008C25)

摘　　要：目的比较不同血浆靶浓度瑞芬太尼对MAP和鼻黏膜微循环的影响。方法择期行全麻下鼻内镜手术患者45例,ASAⅠ或Ⅱ级,随机分为R1、R2和R3组,每组15例,三组术中靶控输注瑞芬太尼4、6、8ng/ml,调整丙泊酚血浆靶浓度维持脑电双频指数(BIS)45～55,术中间断静脉注射维库溴铵维持肌松。持续动态监测记录鼻黏膜微循环血流(NBF)变化,同步监测MAP并评定术野质量。结果与靶控输注前基础值比较,靶控输注瑞芬太尼15min三组患者的NBF均减少(P<0.05),与R1组比较,R2、R3组的NBF均明显减少(P<0.01),R2组和R3组的NBF差异无统计学意义;与靶控输注前基础值比较,靶控输注瑞芬太尼各时点三组MAP均下降(P<0.05),组间差异无统计学意义。三组NBF减少与MAP降低均不存在明显的相关性。与R1组比较,R2组、R3组的术野质量提高,手术时间缩短,出血量明显减少(P<0.05)。结论靶控浓度6ng/ml瑞芬太尼和丙泊酚麻醉用于鼻内镜手术能明显减少NBF,提供理想的术野且不会显著降低血压。Objective To compare the effects of different target plasma concentrations （C.r） of remifentanil on mean arterial blood pressure （MAP） and nasal mucosal blood flow during endoscopic nasal sinus surgery. Methods Forty-five ASA Ⅰ or Ⅱ patients undergoing elective endoscopic nasal sinus surgery were randomly divided into three groups according to C-F of remifentanil： 4,6 and 8 ng/ml （group R1 ,R2 ,R3） （n=15）. ECT, BP, HR, SpO2, PETCO2 and BIS were monitored during anesthesia. Laser Doppler flowmetry （LDP） was used to measure the mucosal blood flow on nasal septum （NBF） continuously. MAP was recorded simultaneously for 15 min. The score of surgical field quality （SSFQ） was assessed by the same surgeon who was blinded to the research. Results NBF decreased significantly in group R1, R2 and R3 compared with baseline（P〈0.05）. It was more obvious in Re and Ra but there was no significant difference between them. MAP decreased significantly after anesthesia in group R1, R2 and R3 without any difference among the groups. No relationship was found between NBF and MAP within groups. SSFQ was significantly lower, the duration of operation was shorter and hemorrhage was more decreased in group R2 and R3 than group R1, Conclusion Remifentanil （CT= 6 ng/ml） combined with propofol （CT= 3 μg/ml）is a good anesthesia protocol for endoscopic sinus surgery with less hemorrhage, higher surgical field quality and without systemic hypotension.

关 键 词：哌啶类 药物释放系统 内窥镜检查 激光多普勒流量测定 降压 控制性 

分 类 号：R614[医药卫生—麻醉学]