靶控输注瑞芬太尼控制性降压在肩关节镜手术中的临床研究  

Clinical Study of Controlled Hypotension with Remifentanil TCI during Shoulder Arthroscopic Surgery

作　　者：赵昭[1] 陈静霞 魏怡雯[1] 项明方[1] 吴宇思 刘志恒[1] 

机构地区：[1]深圳市第二人民医院,广东深圳518039

出　　处：《深圳中西医结合杂志》2017年第19期5-7,共3页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：广东省医学科学技术研究基金项目资助课题(B2015113)

摘　　要：目的:探讨靶控输注瑞芬太尼用于肩关节镜手术控制性降压的安全性和可行性。方法:选取深圳市第二人民医院2015年8月至2017年1月择期接受肩关节镜手术患者60例,随机分为硝酸甘油组(Ⅰ组)和瑞芬太尼靶控输注组(Ⅱ组),两组麻醉诱导和维持方法相同。Ⅰ组:用微量泵静脉输注0.01%硝酸甘油,剂量为3~6μg·kg^(-1)·min^(-1),根据平均动脉压(MAP)调节硝酸甘油的用量,Ⅱ组:靶控输注瑞芬太尼(效应室靶浓度3~6 ng·m L^(-1),Minto药代动力学模型),根据MAP调节瑞芬太尼效应室浓度。维持MAP在55~65 mmHg(1 mmHg=0.133 k Pa)。分别记录两组患者基础血压和心率(HR)、降至目标血压时间、控制性降压30 min后HR、手术时间、术后完全清醒时间、术中术野质量评分和不良反应。结果:两组患者基础血压、HR比较,差异无统计学意义(P>0.05)。开始降压后,Ⅱ组降至目标血压的时间与Ⅰ组比较,差异具有统计学意义(P<0.05);Ⅱ组控制性降压后30 min HR与Ⅰ组比较,差异具有统计学意义(P<0.05);Ⅱ组手术时间、术中术野质量评分与Ⅰ组比较,差异具有统计学意义(P<0.05)。而两组患者术后完全清醒时间比较,差异无统计学意义(P>0.05),两组均未发生不良反应。结论:瑞芬太尼靶控输注控制性降压用于肩关节镜手术可使控制性降压过程快速平稳,缩短手术时间,改善术野质量,减少术中出血量。Objective To investigate the effect and safety of remifentanil target controlled infusion（TCI） as a technique of controlled hypotension during shoulder arthroscopic surgery. Methods From Aug. 2015 to Jan. 2017 sixty patients arranged for shoulder arthroscopic surgery were randomLy divided into two groups： group Ⅰ was given nitroglycerin and group Ⅱ was given remifentanil TCI Group Ⅰ received 0.01 % nitroglycerin 3 ～ 6 μg/kg/min, group Ⅱ received temifentanil TCI（ target plasma concentration 3～ 6 ng/mL）.In both groups, the mean arterial pressure（MAP） decreased to 55 ～ 65 mmHg gradually. Recorded MAP and HR before induced, the time to target MAP, MAP after controlled hypotension 30 min, operation time, recovery time, quality of surgery field of the two groups, and adverse reaction were recorded as well. ResultsThere was no significant difference in baseline blood pressure and HR between the two groups（P〈0.05）. After the depressurization, the time of group Ⅰ was 11.07 ± 3.27 min, the time of group Ⅱ was 5.17 ± 2.04, the group Ⅱ decreased to the target blood pressure（P〈0.05） The operation time of group Ⅰ was 87.00 ± 8.84 min, the operation time of group Ⅱ was 69.87 ± 9.53 min, the operation of group Ⅱ was better than that of group Ⅰ（P〈0.05）. The quality of the operation group was 1.77 ± 0.63 in the group Ⅰ and 1.43 ± 0.57 in the Ⅱ group. The group Ⅱ was better than the group Ⅰ（P〈0.05）. There was no significant difference in the time of complete awake between the two groups（P〈0.05）, and there was no adverse reaction in the two groups.. Conclusion Remifentanil TCI induced controlled hypotension for arthroscopic surgery can make the controlled hypotension process fast and smooth, shorten the operation time, improve the quality of surgery, reduce the amount of intraoperative blood loss.

关 键 词：靶控输注技术 瑞芬太尼 控制性降压 肩关节镜手术 

分 类 号：R684[医药卫生—骨科学]