全凭静脉麻醉复合尼卡地平控制性降压在正颌手术中应用研究

Controlled hypotension with total intravenous anesthesia combined with nicardipine in application to orthognathic surgery

目的观察全凭静脉麻醉复合尼卡地平控制性降压在正颌手术中的应用效果。方法选择2010年1—11月于中国医科大学口腔医学院择期行正颌手术的患者40例,随机分为N组(复合尼卡地平组)和RP组(瑞芬太尼复合丙泊酚组),每组各20例。两组实施控制性降压术中有创平均动脉压(MAP)目标均维持55～65mmHg(1mmHg=0.133kPa)。记录两组诱导前及降压前后各个时点MAP及心率(HR)值并进行比较,同时记录术中输液量、出血量及尿量。结果实施降压后5min两组基本达到目标血压,降压期间MAP均低于降压前(P<0.01);RP组在停止降压后5、10min时MAP及HR均低于N组,差异有统计学意义(P<0.05)。两组输液量相似,但N组尿量明显多于RP组,差异有统计学意义(P<0.05)。N组瑞芬太尼与丙泊酚用量均低于RP组。结论全凭静脉麻醉复合尼卡地平用于正颌手术控制性降压起效迅速,降压平稳,安全有效。

Objective To observe and evaluate the effect of controlled hypotension by total intravenous anesthesia com- bined with nicardipine in oral maxillofacial orthognathic surgery. Methods Forty patients, scheduled for orthognathic surgery at the Stomatology Hospital Affiliated to China Medical University from Jan. to Nov 2010, were randomly divided into two groups：group N received nicardipine and total intravenous anesthesia with remifentanil and propofol; group RP received total intravenous anesthesia with remifentanil and propofol. During the operation, group N was performed con- trolled hypotensinn by nicardipine mainly, group RP by remifentanil and propofol. In both groups, the invasive mean arte- rial blood pressure was maintained within the target range of 55-65mmHg. Record and compare MAP and I-/R value at each point of 2 groups before induction and before and after controlled hypotension; simultaneously record intraoperative fluid volume, bleeding volume and urine output. Results Five min after controlling hypotension, 2 groups achieved the target blood pressure basically. MAP in both groups were significantly lower than those before anesthesia （P 〈 0.01 ）dur- ing controlled hypotension. Both MAP and HR in group RP were significantly lower than those in group N （P 〈 O.05）at 5 and 10 rain after terminating controlled hypotension. In the similar case of fluid volume, urine output in group N was significantly more than those in group RP（P 〈 0.05）. Drug dosage of remifentanil and propofol in group N was both lower than those in group RP. Conclusion Total intravenous anesthesia combined with nicardipine can be used for controlled hypotension in orthognathic surgery which is rapid, steady, safe and effective.