神经外科手术中瑞芬太尼与硝普钠控制性降压效果比较

THE EFFECTS COMPARISON OF CONTROLLED HYPOTENSION INDUCED BY IN NEUROSURGERY SODIUM NITROPRUSSIDE AND REMIFENTANIL

目的：比较神经外科手术中瑞芬太尼和硝普钠（SNP）控制性降压的效果。方法：60例择期开颅手术病人,随机分为瑞芬太尼组（R组）和SNP组（S组）。两组病人麻醉诱导及维持方法相同。R组以瑞芬太尼0.1～0.5μg/kg·min维持降压;S组以SNP 0.5～3μg/kg·min维持降压,均将平均动脉压（MAP）降至60～65mmHg,持续60min。观察两组病人术中MAP、心率（HR）变化以及失血量及清醒拔管时间。结果：降压实施后两组病人的MAP均达预定目标,组间比较差异无显著意义（P〉0.05）。降压期间R组HR显著低于降压前（P〈0.05）,而S组显著高于降压前（P〈0.05）,组间比较差异非常显著（P〈0.05）。两组病人失血量及清醒拔管时间差异无显著意义。结论：神经外科手术中应用瑞芬太尼行控制性降压安全、有效,且优于硝普钠。

Objective：To compare effects of remifentanil and sodium nitroprusside（SNP） for controlled hypotension during neurosurgical operation.Methods：60 patients with craniotomy were randomly devided into group R（30 cases） and group S（30 cases）.Anesthesia induction and maintenance in both groups were using the same method.Group R were infused with remifentanil 0.1～0.5μg/kg·min and group S were infused with SNP 0.5～3μg/kg·min for controlled hypotension.The target of controlled hypotension was fixed at MAP 60～65mmHg,which was maintained for 60 minutes.The hemodynamic changes in two groupswere recorded during surgery and amount of blood loss,extubation time were also compared.Results：The patients in both groups could maintain MAP at 60～65mmHg during controlled hypotension.There wasn＇t significant difference during controlled hypotension between two groups（P〉0.05）.HR was significantly reduced in R group compared with pre-controlled hypotension（P〈0.05） and was significantly increased in S group during controlled hypotension（P〈0.05）.The amount of blood loss and extubation time weren＇t significant difference between two groups.Conclusion：Remifentanil is a safe and effective drug for controlled hypotension in neurosurgical operation and its clinical efficacy is better than that of sodium nitroprusside.