不同速率输注瑞芬太尼复合丙泊酚应用于鼻内窥镜手术控制性降压的临床观察

Effects of Controlled Hypotension in Functional Endoscopic Sinus Surgery with Remifentanil at Different Rates

目的探讨不同剂量瑞芬太尼复合丙泊酚在鼻内窥镜手术中的降压效果。方法ASAⅠ～Ⅱ级择期鼻内窥镜手术患者45例,随机分3组,每组15例。R1,R2和R3组术中静脉泵入瑞芬太尼速率为0.19,0.28和0.37μg·kg-1·min-1,术中以0.11μg·kg-1·min-1的基础速率复合输注丙泊酚,根据脑电双频指数(BIS)值调节丙泊酚的输注速度,以维持稳定的麻醉深度。分别在降压前(t0)、降压后20min(t1)、40min(t2)及术毕(t3)作血气分析,并记录各时点的平均动脉压(MAP)、心率(HR)。结果在t1时点R2组和R3组HR、MAP均有显著下降(P<0.05);而R1组在t2时点才出现显著下降(P<0.05);R1组和R3组的t2时点与t1时点比较HR、MAP差异有显著性(P<0.05),而R2组两时点HR、MAP差异无显著性(P>0.05)。R3组术中t1、t2与术前t0比较,氧分压(PaO2)、二氧化碳分压(PaCO2)和乳酸(Lac)含量差异有显著性(P<0.05),而在其他两组差异无显著性(P>0.05)。结论在鼻内窥镜手术中,以0.28μg·kg-1·min-1输注瑞芬太尼复合丙泊酚,降压作用明显、平稳,并且不会造成组织灌注压过低导致组织低氧。

Objective To investigate the effect of controlled hypotension in functional endoscopic sinus surgery（FESS） with remifentanil at different rates. Methods Forty-five patients（ASA Ⅰ - Ⅱ ） were randomly divided into three groups. The patients in group R1,R2, and R3 were injected with remifentanil at a rate of 0. 19, 0. 28 and 0. 37 μg · kg^-1 min^-1, respectively. Infuse propofol at a basic rate of 0.11 μg · kg^-1 min^-1. According to BIS value, adjusted the rate of propofol to maintain the stability of anesthesia. Made blood gas analysis and recorded MAP and HR at to （ before the operation）, t1 （20 minutes after the operation） ,t2 （40 minutes after the opertation）and t3 （after the operation）. Results The MAP and HR in the patients of group R2 and group R3 were reduced at t1 （P 〈0.05） ,while these in the patients of group R, were reduce at t2.And these in the patients of group R3 continued to reduce at t2 （ P 〈 0.05 ）, which didn＇ t happen in group R2. The indexes of PaO2 , PaCO2 and Lac had statistic distinction only in group R3 （ P 〈 0.05 ）. Conclusion Irtf/usion of remifentanil at a rate of 0.28 μg · kg^-1 · min^-1 was a more suitable ahernative for FESS. It could control hypotension obviously and steadily, and tissues weren＇ t short of oxygen at this rate.