瑞芬太尼在鼻内窥镜手术的应用

Evaluation of remifentanil in functional endoscopic sinus surgery

目的比较瑞芬太尼或异丙酚复合异氟醚静吸麻醉用于鼻内窥镜手术（functional endoscopic sinussurgery,FESS）行控制性降压的效果及苏醒期的特点。方法选择90例择期行鼻内窥镜手术的患者,随机分为瑞芬太尼（A）及异丙酚（B）两组。A组（n=45）诱导采用瑞芬太尼1μg/kg,异丙酚2.5mg/kg及琥珀胆碱1.5mg/kg后气管插管,维持采用瑞芬太尼每分钟0.25μg/kg＋异氟醚。B组（n=45）诱导采用芬太尼2μg/kg,异丙酚2.5mg/kg及琥珀胆碱1.5mg/kg后气管插管,维持采用异丙酚每小时4～6mg/kg＋异氟醚。记录诱导前、诱导后、插管后、切皮后、切皮后20min、切皮后60min、拔管后、拔管后20min、拔管后60min的平均动脉压（mean atrial pressure,MAP）、心率（heart rate,HR）;记录术中所用肌松药总量,所需艾司洛尔或麻黄素的总量;由同一术者在MAP稳定于60～70mmHg后行术野质量（scores of surgical field quality,SSFQ）评定;记录患者术后躁动、恶心呕吐、疼痛等不良反应。结果A组病人在术中血流动力学方面比B组病人平稳,拔管时间较短,手术视野渗血少,且A组病人实施控制性降压所需的艾司洛尔用量小,且术后躁动、恶心呕吐发生率低（P〈0.05）。结论瑞芬太尼复合异氟醚静吸麻醉在鼻内窥镜手术患者有较明显的临床使用价值。

Objective To evaluate the clinical efficacy of remifentanil combined with isoflurane in functional endoscopic sinus（FESS）surgery.Methods Ninety ASAⅠ-Ⅱ patients undergoing FESS surgery were randomly divided into two groups：Group A（Remifentanil-Isoflurane,n=45）and group B（Propofol-Isoflurane,n=45）.Patients in group A were induced with remifentanil 1 μg/kg,propofol 2.5 mg/kg and scoline 1.5 mg/kg,then maintained with remifentanil 0.25 μg/kg per minute combined with isoflurane with the exhaled concentration 0.8%-1.2%.While those in group B were induced with fentanil 2 μg/kg,propofol 2.5 mg/kg and scoline 1.5 mg/kg,then maintained with propofol 4-6 mg/kg per hour combined with isoflurane with the same concentration in group A.Results The hemodynamics of patients of different time points were more stable in group A.The time of extubation was shorter and the level of wakeness was much better in group A,which also provided good surgical conditions for endoscopic sinus surgery operation.The amounts of esmolol and ephedrine hydrochloride were fewer in B group.Conclusions Remifentanil combined with isoflurane could be regarded as one of the anesthetic protocol of choice in patients undergoing FESS surgery.