瑞芬太尼复合异氟烷控制性降压在颅颌面整形外科手术中的应用

Application of controlled-hypotension by combination of remifentanil and isoflurane in patients undergoing craniofacial plastic surgery

目的:探讨瑞芬太尼复合异氟烷控制性降压在颅颌面整形外科手术中的效果和安全性。方法:择期术中需行控制性降压颅颌面整形外科手术患者46例,随机分为瑞芬太尼组(R组)和硝酸甘油组(C组),每组23例,分别于麻醉前(T0)、麻醉诱导后(T)、降压开始3min(T+3)、5min(T+5)、10min(T+10)、15min(T+15)、20min(T+20)、25min(T+25)、30min(T+30),记录心率(hear trate,HR)、收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、平均压(mean pressure,MAP)。结果:两组患者控制性降压期间各时点的MAP均有明显下降,与基础值比较差异有统计学意义(P<0.01);R组控制性降压期间各时点的HR较基础值明显减慢(P<0.01),与C组同时间点HR比较差异有统计学意义(P<0.01)。结论:瑞芬太尼与异氟烷静吸复合麻醉能有效平稳地降低血压,是颅颌面整形外科手术较为安全、有效的降压方法。

Objective To observe the effect and safety of controlled-hypotension by combination of remifentanil and isoflurane in patients undergoing craniofacial plastic surgery.Methods 46 cases of patients who received craniofacial plastic surgery were chosen,and randomized into two groups：Remifentanil group（group R） and nitroglycerin group（group C）,each 23 people.Recorded the two group＇s HR,SBP,DBP and MAP at the following time points：before anesthesia（T0）,after induction of anesthesia（T）,after controlled-hypotension 3min（T＋3）,5min（T＋5）,10min（T＋10）,15min（T＋15）,20min（T＋20）,25min（T＋25） and 30min（T＋30）.Results Two groups＇ patients can achieve the MAP target after implementing the controlled-hypotension.The MAP of patients in the two goups during controlled-hypotension was significantly decreased,compared with baseline was significantly（P0.01）;The HR in group R slowed down compared with baseline（P0.01）,compared with group C was also significantly（P0.01）.Conclusion The controlled-hypotension by combination of remifentanil and Isoflurane is safe and effective in patients undergoing craniofacial plastic surgery.