靶控瑞芬太尼复合地氟醚在脊椎手术中控制性降压的临床观察

Observation of Target Controlled Remifentanil Combined with Desflurane Induced Hypotension in Spinal Operation

目的：探讨靶控瑞芬太尼复合地氟醚在脊椎手术全身麻醉中控制性降压的临床效果。方法：选取2012年3月-2013年10月在笔者所在医院接受外伤致脊椎骨折经后入路切口开放复位内固定手术的患者36例，ASA分级Ⅰ~Ⅱ级，随机分为瑞芬太尼-地氟醚组（瑞芬太尼组）和芬太尼-丙泊酚组（对照组），各18例。所有患者术前均无明显心、肺、肾、内分泌疾病和高血压病史。比较瑞芬太尼组和对照组麻醉前后平均动脉压、心率、血压恢复时间、拔管时间、睁眼时间及出血量。结果：瑞芬太尼组手术后10、30、60 min平均动脉压、心率均显著低于对照组（P〈0.05），停药后5 min平均动脉压高于对照组，心率亦高于对照组（P〈0.05）；瑞芬太尼组血压恢复时间、拔管时间、睁眼时间及术中出血量均显著低于对照组（P〈0.05）。结论：靶控输注瑞芬太尼复合地氟醚控制性降压应用于脊椎手术控制性降压效果理想。

Objective：To investigate the clinical effect of target controlled（TCI） controlled hypotension with Remifentanil and Desflurane in spinal surgery of general anesthesia.Method：36 patients with spinal trauma fracture received posterior incision open reduction and internal fixation surgery were selected in our hospital from March 2012 to October 2013.ASA classification Ⅰ-Ⅱ,they were randomly divided into Remifentanil-Desflurane group（Remifentanil group） and Fentanyl-Propofol group（the control group）,18 cases in each group.Preoperative patients had no obvious heart,lung, kidney,endocrine disease and hypertension.Remifentanil group and the control group before and after anesthesia of mean arterial pressure,heart rate,blood pressure,recovery time and extubation time,eye opening time and quantity of hemorrhage were compared.Result：Remifentanil group after operation in 10,30,60 minutes,mean arterial blood pressure and heart rate were significantly lower than those of the control group（P〈0.05）,5 minutes after discontinuation of mean arterial blood pressure was higher than that of the control group,the heart rate was higher than that of the control group（P〈0.05）.Remifentanil group blood pressure recovery time,pull the bleeding pipe time to eye opening,time and operation in volume were significantly lower than those of the control group（P〈0.05）.Conclusion：Target controlled infusion of Remifentanil with Desflurane controlled hypotension used in spinal surgery control has an ideal antihypertensive effect.