七氟烷麻醉复合瑞芬太尼控制性降压用于神经内窥镜手术的临床观察  

Clinical Efficacy of Controlled Hypotension Induced with Sevoflurane and Remifentanil during Neuroendoscopic Surgery

作　　者：殷税香[1] 石金山[1] 章放香[1] 康新国[1] 

机构地区：[1]贵州省人民医院麻醉科,贵阳市550002

出　　处：《中国药房》2011年第28期2621-2623,共3页China Pharmacy

摘　　要：目的:观察七氟烷麻醉复合瑞芬太尼控制性降压用于神经内窥镜手术的临床效果。方法:将择期神经内窥镜下相关手术56例,ASAⅠ～Ⅱ级,随机均分为试验组和对照组。2组术中吸入七氟烷1.0～1.5 MAC维持麻醉。试验组于切开脑膜时以瑞芬太尼2μg.kg-1静脉注射,后予0.08～0.5μg.kg-1.min-1,控制及维持平均动脉压(MAP)于60～65 mmHg。对照组不行控制性降压。连续监测MAP、心率(HR)、脉搏血氧饱和度(SpO2)、呼气末二氧化碳分压(PETCO2)、呼气末七氟烷浓度(ETSev)、脑电双频指数(BIS)、中心静脉压(CVP)。记录手术时间、控制性降压起效时间、控制性低血压持续时间(即血压控制到低血压状态持续的时间)、出血量、尿量、补液总量、拔管时间、苏醒时间。2组由同一手术者操作并于内窥镜进入手术野操作后5、15、30、45、60 min进行手术野质量(SSFQ)评分。结果:试验组控制性降压起效时间(4.0±0.3)min,控制性低血压持续时间(72.4±10.6)min,停用瑞芬太尼后(5.8±0.5)min后血压自动恢复到降压前水平。试验组手术时间明显短于对照组(P<0.05),出血量明显少于对照组(P<0.05)。术毕拔管时间、苏醒时间2组比较无显著性差异(P>0.05)。试验组在内窥镜进入手术野操作后各时点,MAP均降到目标范围,与降压前和对照组比较有显著性差异(P<0.01),HR比降压前和对照组明显减慢(P<0.05),试验组各时间点SSFQ评分明显低于对照组(P<0.05)。结论:七氟烷麻醉复合瑞芬太尼控制性降压用于神经内窥镜手术,降压效果确切,易于调控,明显改善手术野质量,为术者提供清晰的手术野,不影响患者术后苏醒。OBJECTIVE： To observe the clinical efficacy of controlled hypotension induced by sevoflurane and remifentanil during neuroendoscopic surgery. METHODS ： 56 patients （ASA class Ⅰ-Ⅱ ） scheduled for selective surgery under neuroendoscopy were randomly divided into controlled hypotension induced by sevoflurane and remifentanil group （trial group） and non-controlled hypotension induced by sevoflurane group （control group）. The anesthesia of 2 groups was maintained with sevoflurane （1.0~1.5 MAC）. Trial group received remifentanil 2 μg·kg^- 1 before the incision of endocranium, followed by a 0.08~0.5 μg.kg^-1 .min^-1 continuous infusion to maintain a mean arterial pressure （MAP） between 60 and 65 mmHg （MAP should be indicated in Chinese at the first time）. Control group were not offered with controlled hypotension. MAP, HR, SPO2, PETCO2, ETSev, BIS, and CVP were monitored continuously. Furthermore, the time of operation duration, extubation, and anesthesia recovery were recorded, and the volume of the blood loss, urinary output and the total fluid input were also recorded. The patients of 2 groups had the same surgeon. The SSFQ score were recorded at 5, 15, 30, 45, 60 rain after the endoscopy going into the surgical field. RESULTS： In trial group, controlled hypotension came into effect at （4.0 ± 0.3） min, and lasted for （72.4 ± 10.6） min. The blood pressure restored at （5.8 ± 0.5） min after stopping remifentanil infusion. The operation time and blood loss of trial group were less than those of control group （P〈0.05）. There were no significant difference between 2 groups in the time of extubation and recovery （P〉0.05）. The MAP of trial group was controlled in the target range at each time point after the endoscopy going into the surgical field. The MAP had significant difference between trial group and control group （P〈0.01）. HR of trial group was significantly slower than before treatment and control group. The SSFQ score of trial group was also lowe

关 键 词：瑞芬太尼 控制性降压 七氟烷 神经内窥镜 手术 手术野质量 

分 类 号：R614.27[医药卫生—麻醉学]