瑞芬太尼控制性降压对髋关节术中血液保护的临床观察

Application of controlled hypotension with remifentanil on blood conservation in hip joint surgery

目的观察瑞芬太尼控制性降压对髋关节手术的血液保护效果。方法择期60例髋关节手术患者,随机分成硝酸甘油组(C组)和瑞芬太尼组(R组),每组30例。分别记录控制性降压0 min(T0)、10 min(T1)、40 min(T2),控制性降压结束0min(T3)、10 min(T4)等时点的MAP、HR、CVP和麻醉深度指数(CSI)值,并行血气分析和术野质量评分(SSFQ),记录失血量、输异体血量、麻醉时间、手术时间、控制性降压时间、术毕拔管时间等指标。结果两组SSFQ差异无统计学意义(P>0.05);两组患者在控制性降压期间均能维持理想的目标血压,但R组控制性降压的起效及血压回升时间短于C组(P<0.05);T4时,R组MAP和HR与T0时差异无统计学意义(P>0.05),而C组与T0时差异有统计学意义(P<0.05)。结论瑞芬太尼控制性降压用于髋关节手术安全、有效,并且优于硝酸甘油。

Objective To observe the effects of controlled hypotension with remifentanil on blood conservation in hip joint operation. Methods Sixty patients scheduled for hip joint operation were randomly divided into the nitroglycerin group （ group C） and remifentanil group （ group R） with 30 cases in each group. MAP, HR, CVP and blood gas analysis results were recorded at the controlled hypotension 0min （T0）, 10 min （ T1 ）, 40 min （ T2）, the end of controlled hypotension 0min （T3）, and 10 min （T4） ; meanwhile, the score of surgical field quality （ SSFQ ） was assessed, and the volume of hemorrhage and transfusion, the time of anesthesia and operation, the time of controlled hypotension and extubation, ect were recorded. Results The SSFQ of two groups had no significant difference （ P 〉 O. 05 ） ; patients of two groups all could maintain the desired target blood pressure during the time of controlled hypotension, but the time of depressurization and pressure recovery in group R was superior to that of group C （ P 〈 O. 05） ; compared with the results before controlled hypotension, MAP and HR after controlled hypotension 10 min in group R had no significant statistical difference （P 〉 0.05 ）, while there was significant difference （P 〈 O. 05） in group C. Conclusion Remifentanil can induce and maintain controlled hypotension in patients of hip joint operation safely and effectually, meanwhile, it is superior to nitroglycerin.