瑞芬太尼复合七氟醚控制性降压在神经外科手术中对内脏灌注的影响

The influence of remifentanil-sevoflurane induced deliberate hypotension on splanchnic perfusion in patients undergoing intracranial surgery

目的:探讨瑞芬太尼复合七氟醚控制性降压在神经外科手术中对内脏灌注的影响。方法:20例行择期神经外科手术的患者,ASA分级Ⅰ～Ⅱ,麻醉诱导后吸入1MAC七氟醚维持麻醉,开始降压时通过调节瑞芬太尼的剂量0.2～0.5μg/(kg.min),直至收缩压较基础值降低30%或MAP不低于60mmHg。记录降压前即刻(T0)、降压后1h(T1)、降压后2h(T2)、降压后3h(T3)、术后1h(T4)的MAP、HR、胃黏膜二氧化碳分压(PgCO2),同时测血气计算胃黏膜pH值(pHi)。结果:与T0相比,MAP、HR、pHi在T1、T2、T3下降(P<0.05),PgCO2在T1、T2、T3升高(P<0.05),其余各指标在各时间点差异均无显著性(P>0.05)。结论:在神经外科手术中,用瑞芬太尼复合七氟醚行控制性降压后,可引起胃黏膜pHi可逆性改变,降压后3h内的内脏灌注均在正常范围内。

Objective To investigate the influence of remifentanil-sevoflurane induced deliberate hypotension on splanehnic perfusion in patients undergoing intracranial surgery. Methods Twenty ASA I - II patients receiving elective intracranial surgery were studied. After anesthesia induction, all the patients received 1 MAC of sevoflurane for the maintenance of anesthesia. When the blood pressure started to decrease, the dosage of remifentanil was adjusted to 0.2 - 0.5 ug/（kg.min） until the contractive pressure was decreased by 30% of basal blood pressure or MAP was more than 60 mmHg. The MAP, HR, PgCO2, and phi at hypotension （To）, 1 h（T1） ,2 h （T2） ,3 h（T3） after hypotension, and 1 h after surgery （T4） were recorded. Result MAP, HR, and phi at T1, T2, and T3 were decreased （P 〈 0.05）, whilst PgCO2 at T1, T2, and T3 were increased （P 〈 0.05） as compared to T1. There were no significant differences of MAP, HR, PgCO2 among different time spot （P 〉 0.05）. Conclusions There is reversible disturbance of pHi in gastric mucosa after remifentanil-sevoflurane induced deliberate hypotension, but the splanchnic perfusion within 3h after hypotension is within normal range.