瑞芬太尼复合七氟醚控制性降压用于鼻内镜手术的临床研究  

Clinical study ofremifentanil-sevoflurane inducing deliberate hypotension in nasal endoscopic surgery

作　　者：侯明勇[1] 魏江涛[1] 刘海兵[1] 赵荣[1] 

机构地区：[1]成都大学附属医院麻醉科,四川成都610081

出　　处：《四川医学》2012年第12期2082-2084,共3页Sichuan Medical Journal

摘　　要：目的探讨瑞芬太尼复合七氟醚控制性降压用于鼻内镜手术的有效性、可控性。方法 60例择期行鼻内镜手术的患者,随机分为试验组和对照组,每组各30例。两组均采用七氟醚静吸复合麻醉。试验组以瑞芬太尼0.2μg/kg静脉注射,0.1～0.5μg/(kg.min)维持。维持平均动脉压(MAP)为60～65mmHg,直至手术主要步骤结束。对照组以硝酸甘油2μg/kg静脉注射,0.5～3μg/(kg.min)维持。分别记录控制性降压前(T0)、血压降至靶目标后10min(T1)、20min(T2)、30min(T3)、停止降压即刻(T4)时的平均动脉压(MAP)、心率(HR)。记录术中出血量;控制性降压时间;手术结束至拔出气管导管时间(拔管时间);术野质量评分。结果试验组术野质量评分明显优于对照组(P<0.05),控制性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),试验组失血量明显少于对照组(P<0.05)。患者清醒拔管时间两组无差异(P>0.05)。结论瑞芬太尼复合七氟醚控制性降压用于鼻内镜手术是有效的、易控的。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、失血量少等优点。Objective To investigate the effectiveness and controllability of remifentanil-sevoflurane inducing deliberate hypotension in nasal endoscopic surgery. Methods 60 cases of elective nasal endoscopic surgery were randomly divided into trial group and control group. All the patients received sevoflurane combined anaesthesia. Remifetanil was intravenously injected by 0. 2txg/kg and maintained by 0. 1 ～ 0. 5μg/（ kg ·min） in trial group. Nitroglycerin was intravenously injected by 2μg/kg and maintained by 0. 5 ～ 3μg/（ kg · min） in trial group. MAP was maintained 60 ～ 65mmHg until the operation was over. The MAP, Heart rate （HR） were recorded before hypotension（To）, 10rain （TI） and 20min （T2） and 30min（T3） ＂after blood pl＇essure reached the point （T1）,and hypotension was stopped（T4）. We reco^ed the volume of hemorrhage, time of controlled hypoten- sion, time from operation over time to the decannulation time and scores of surgical field quality. Results HR was significantly lower than before controlled-blood pressure in trial group （ P 〈 0. 05 ） , and HR was higher than before controlled-blood pressure in the control group （ P 〈0. 05 ）, the blood loss in trial group was less than that of the control group （ P 〈0. 05 ）. Awake deca,mula- tion time of patients was no difference in two groups （ P 〉 0. 05 ）. Operation field quality scores of the trial group was better than that of control group （ P 〈 0.05 ）. Conclusion Rachel fentanyl combined with sevoflurane nasal for controlled hypertension was effective and easy control in endoscopic surgery. Compared with nitroglycerin, rachel fentanyl for controlled hypertension has more advantages in slowing down the heart rate, controlling blood pressure smoothly and reducing the blotM loss.

关 键 词：瑞芬太尼 七氟醚 硝酸甘油 控制性降压 鼻内镜手术 

分 类 号：R614[医药卫生—麻醉学]