脑膜瘤术中瑞芬太尼联合异氟烷控制性降压效果观察

Controlled hypotension by remifentanil combined with isoflurane in meningiomas surgery

目的：观察异氟烷麻醉下瑞芬太尼控制性降压在脑膜瘤手术中的应用效果、术野质量及对应激反应的影响。方法：40例ASAⅠ～Ⅱ级择期脑膜瘤手术,随机分为瑞芬太尼组（R组）及硝普钠组（F组）控制性降压。对比两组麻醉前及控制性降压期间血压、心率及术野质量。结果：两组控制性降压期间收缩压、平均动脉压均低于麻醉前（P〈0.01）。R组控制性降压期间收缩压、平均动脉压、心率值均低于F组（P〈0.01）。趋势图显示：R组心率较F组平稳。R组术野质量明显好于F组（P〈0.01）。结论：脑膜瘤手术中瑞芬太尼控制性降压可达理想的降压效果,术野质量高,有效的抑制术中应激反应。

Objective：To observe the effect of anesthetic remifentanil combined with isoflorane in controlled hypotension in meningiomas surgery and its influence on the surgical field quality and stress reaction. Methods ：Forty patients with ASA gradeⅠ～Ⅱ undergoing selective endoscopic sinue surgery were randomly divided into remifentanil group（ R group） and sodium nitroprusside group（ F group）. The blood pressure,heart rate and the surgical field quality were compared between the two groups before anesthesia and during controlled hypotension. The surgical field quality was also determined during controlled hypotension. Results：The systolic blood pressure（SBP） and mean arterial pressure （MAP） of the two groups during controlled hypotension were lower than before anesthesia （P 〈 0.01 ）. The SBP, MAP and HR were lower in group R than in group F during controlled hypotension（P 〈0.01 ）. Compared with group F,the surgical field quality in group R was significantly better. The trend curves showed that the heart rate was stable in group R compared with that in group F（P 〈0.01 ）. Conclusions：Remifentanil is effective in controlling the blood presure during meningiomas surgery, which may provide a better surgical field quality and inhibit the stress response.