瑞芬太尼控制性降压在鼻内镜手术中的应用

The application of controlled hypotension with remifentanil in nasal endoscopic surgery

目的研究硝普纳(SNP)复合瑞芬太尼在鼻内镜手术中行控制性降压麻醉的有效性和安全性。方法60例需行鼻内镜手术者,随机分为A、B组,每组30例。A组用局麻加强化;B组用微量泵注瑞芬太尼和异丙酚,当需要鼻内镜控制性降压麻醉时,B组泵注SNP复合瑞芬太尼将M ABP降至并维持于60-70mmHg。观察术前、术中,术后10分钟时的血流动力学变化。结果B组的降压效果满意,且HR相对稳定。血压下降速度B组明显快于A组。B组血流动力学变化幅度优于A组(P<0.05)。结论瑞芬太尼复合SNP能强化SNP的降压效果,减少出血量,缩短手术时间,维持降压中血流动力学的稳定。

Objective To study the efficacy and safety of sodium nitroprusside（SNP） with remifentanil used for controlled hypotension in nasal endoscopic surgery. Methods Sixty children undergoing operation were randomly divided into A and B group. Local anesthesia was in A group; Anesthesia was maintained with the continuous infusion of remifentanil and propofol in B group. Controlled hypotension was performed and the MAP was reduced and maintained between 60 - 70 mmHg with the continuous infusion of SNP. Hemodynamic changes before operation, in operation and 10 min after operation were observed. Results Data in B groups showed high satisfaction with hypotension, HR was stability in B group. Hemodynamic changes were better in B group than in A group（P〈0. 05）. Conclusions Remifentanil could potentiate the hypotensive effect of SNP ,decrease the bleeding amount,shorten the operation time and maintain a stable hemodynamics during controlled hypotension.