雷米芬太尼控制性降压对颅脑手术患者血液动力学的影响

Effects of deliberate hypotension with remifentanil on Hemodynamics in neurosurgical patients

目的 观察神经外科手术中雷米芬太尼控制性降压对血液动力学的影响。方法 20例ASAⅠ～Ⅱ级择期行颅脑手术患者，采用全凭静脉复合麻醉，术中持续泵注雷米芬太尼行控制性降压，维持MAP60～70mmHg，观察降压前（T0）、降压达目标时（T1）、维持降压15min（T2）、30min（T3）、停降压15min（T4）、30min（T5）6个时点的MAP、HR、心输出量（CO）、心脏指数（CI）、心室收缩加速度指数（ACI）、左心做功（LCW）、外周血管阻力（SVR）的变化。结果 与T0比较，T1、T2、T3时点MAP、SVR、LCW均显著降低（P〈0．01）；HR亦明显减慢（P〈0．05）；CO、CI、ACI无明显降低。结论 神经外科手术中行雷米芬太尼控制性降压安全、有效，具有对心功能影响小的优点。

Objective To study the effects of deliberate hypotension induced by remifentanil on the hemodynamics during neurosurgical operation. Methods Twenty ASA class Ⅰ or Ⅱ patients undergoing elective neurosurgery were received propofol total intravenous anesthesia（TIVA）. Deliberate hypotension of MAP 60-70 mmHg was induced after dura opening by continuous infusion of remifentanil at 0.5-2μg·kg^-1·min^-1. Hemodynamics were measured at 6 time points of perihypotension. Results Compared with the values before hypotension,significant decreases in MAP,SVR, LCW and HR were observed （P〈0.05,P〈0.01） ,but no significant decreases in CO,CI,ACI were seen during deliberate hypotension. Conclusion Deliberate hypotension with remifentanil is effective and safe with less influence on cardiac function in neurosurgical patients.