瑞芬太尼复合七氟醚控制性降压麻醉在鼻内窥镜手术中的应用  

Effect of combined remifentanil-sevoflurane anesthesia on endoscopic sinus surgery

作　　者：池芳 

机构地区：[1]天津市北辰区中医医院麻醉科,300400

出　　处：《淮海医药》2018年第1期1-3,共3页Journal of Huaihai Medicine

摘　　要：目的:探讨瑞芬太尼复合七氟醚控制性降压麻醉在鼻内窥镜手术的安全性和有效性。方法:选择66例择期鼻内窥镜手术患者,随机分成对照组和降压组,每组33例,2组均在静吸复合全身麻醉下行鼻内窥镜手术。对照组不施行控制性降压,术中血压维持在术前基础水平左右,降压组术中施行瑞芬太尼复合七氟醚控制性降压,使平均动脉压(MAP)维持在55~65mm Hg。记录控制性降压前(T1)、手术开始后10 min(T2),30 min(T3),手术结束后拔管前(T4)的平均动脉压和心率(HR),术野质量评分,手术失血量及手术时间。结果:对照组患者术中、术后与术前相比平均动脉压升高,心率明显加快,差异有统计学意义(P<0.01);降压组患者术前、术中及术后平均动脉压和心率比较,差异无统计学意义(P>0.05);2组患者平均动脉压比较,T1无统计学差异,T2,T3及T4有统计学差异(P<0.01);2组患者心率比较,T1和T4时心率无统计学差异(P>0.05),T2和T3时的心率降压组明显慢于对照组,有统计学差异(P<0.01);降压组的术野质量明显优于对照组,降压组患者的手术失血量和手术时间均少于对照组,且2组比较差异均有统计学意义(P<0.01),术中术后均无麻醉相关并发症发生。结论:瑞芬太尼复合七氟醚控制性降压麻醉用于鼻内窥镜手术,能安全有效的控制血压,明显减少失血量,缩短手术时间,有一定的临床意义。Objective： To study the effect of combined remifentanil-sevoflurane anesthesia on the endoscopic sinus surgery. Methods： a total of 66 patients undergoing nasal endoscopic surgery were randomly divided into a control group（ n = 33） and an antihypertensive group（ n = 33）. The two groups both received endoscopic sinus surgery under static inhalation combined with general anesthesia. The control group maintained the preoperative blood pressure during the operation. The antihypertensive group was given controlled hypotension by remifentanil combined with sevoflurane. The mean arterial pressure was maintained at 55 ~ 65 mm Hg. Heart rate（ HR）,surgical field quality score,operative blood loss and operative time were recorded before the controlled hypotension（ T1）,10 minutes after the operation start（ T2）,30 minutes after the operation start（ T3）,and before extubation at the end of surgery（ T4）. Results：The mean arterial pressure（ MAP） and heart rate（ HR） in the control group were significantly higher than those before the operation,and the difference was statistically significant（ P〈 0. 01）. Meanwhile,the preoperative,intraoperative and postoperative MAP and HR of the antihypertensive group did not change,and there was no significant difference（ P〉 0. 05）. In comparison of MAP of the two groups,T1 had no significant difference,but there were significant differences in T2,T3 and T4（ P〈 0. 01）. As for the comparison of HR,there was no significant difference between the two groups at T1 and T4（ P〉 0. 05）,but it was significantly slower at T2 and T3 in the antihypertensive group than in the control group,and there was statistical difference（ P〈 0. 01）. Compared with the control group,the scores of operation field,blood loss and operation time in the antihypertensive group were statistically better（ P〈 0. 01）. Conclusion： Remifentanil combined with sevoflurane in controlled hypotension anesthesia used for nasal endoscopic surgery is safe and eff

关 键 词：控制性降压 瑞芬太尼 七氟醚 鼻内窥镜手术 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]