瑞芬太尼在异氟烷静吸复合麻醉下用于鼻内窥镜手术控制性降压的临床研究

Clinical Research of Controlled Hypotension with Remifentanil in Endoscopic Sinus Surgery Under Isoflurane Balanced Anesthesia

目的探讨瑞芬太尼在异氟烷静吸复合麻醉下用于鼻内窥镜手术控制性降压的有效性、可控性。方法60例择期行鼻内窥镜的患者,随机分为两组,硝普钠组(N组)和瑞芬太尼组(R组),每组各30人。两组均采用异氟烷静吸复合麻醉。桡动脉穿刺置管监测血压。两组均于主要手术步骤开始前进行控制性降压。N组用硝普钠进行控制性降压,MAP维持在50～70mmHg。分别记录控制性降压即将开始前(T0)、血压降至靶目标后10min(T1)、20min(T2)、30min(T3)各时点的MAP、HR;对术野出血情况进行手术野质量评分。记录控制性降压由开始到降至靶目标值所需时间和停用降压药后到拔除气管导管所需时间。结果R组与N组相比,R组手术野质量评分明显优于N组(P<0.05),两组降压前后的HR变化显著,N组反射性心率增快(P<0.05),R组减慢(P<0.05)。R组与N组"降至靶目标血压所需时间"及"手术结束后拔除气管导管的时间"差异无统计学意义(P>0.05)。结论瑞芬太尼用于鼻内窥镜手术控制性降压是有效、易控的。

Objective To discuss the validity and controllability of remifentanil inducing and sustaining controlled hypotension under isoflurane balanced anesthesia. Methods Sixty patients underwent endoscopic sinus surgery were randomly divided into two groups： sodium nitroprusside group （N group） and remifentanil group （R group）. There were 30 persons in every group. Isoflurane balanced anesthesia was performed in two groups. Radial artery was cannulated for direct and continuous MAP monitoring. Controlled hypotension was induced before the main procedure of surgery. The patients were infused continuously by sodium nitroprusside in N group. The patients were infused continuously by remifentanil in R group. MAP was sustained at 50-70 mmHg. The datum of MAP and HR were noted at the controlled hypotension would begin （T0）, blood pressure fell to target 10 min later （T1）, 20 min later （T2）, and 30min later （T3）. The quality of surgical field in terms of blood loss and dryness was rated. The time from beginning controlled hypotension to blood pressure falling to target, and the time from stopping hypotensor to removal of tracheal tube were noted. Results The surgical field scoring of R group was significantly better than that of N group （P〈 0.05）. In R group, heart rate decreased （P〈 0.05）, while in N group there was reflexible heart rate increasing during hypotension （P〈0.05）. The difference of the time that it took for BP felling to target between the two groups was not statistically significant （P 〉 0.05）. No statistically significant difference was found between the two groups in time from completion of operation to pulling out the tracheal tube （P 〉 0.0.5 ）. Conclusions It is effective and easily controlled that remifentanil is applied to controlled hypotension of endoscopic sinus surgery under isoflurane balanced anesthesia.