鼻内窥镜手术中天麻素与瑞芬太尼控制性降压治疗的前瞻性随机对照研究

Prospective randomized controlled study between gastrodin and remifentanil for controlled hypotension in endoscopic sinus surgery

目的比较鼻内窥镜手术中天麻素和瑞芬太尼控制性降压的临床效果、术后疼痛及并发症的变化。方法 80例接受鼻内窥镜手术治疗的患者随机分为天麻素组（G组）和瑞芬太尼组（R组）,每组40例。2组患者采用异丙酚2 mg/kg麻醉诱导插管,术中吸入七氟烷维持麻醉。G组先单次2 mg/kg静脉注射天麻素后再以20 mg/kg持续静脉输注,R组患者靶控持续静脉输注瑞芬太尼3~4 ng/m L,维持平均动脉压（mean arterial pressure,MAP）60~70 mm Hg。记录术中血流动力学指标、术中情况、术后疼痛及不良反应。结果 2组术中控制性降压均效果良好。术后R组MAP和心率均高于G组（P〈0.05）。2组术野质量评分差异无统计学意义。G组术后疼痛评分均明显低于R组（P〈0.05）。G组发生寒颤病例数、使用止吐剂和止痛剂病例数明显少于R组（P〈0.05）。结论术中输注天麻素和瑞芬太尼复合吸入七氟烷控制性降压可以为鼻内窥镜手术提供满意的手术条件。术中使用天麻素较瑞芬太尼具有术后镇痛效果好、术后恶心呕吐及寒颤发生率低等优点。

Objective To compare the changes in postoperative pain, complications and clinical effect between gastrodin and remifentanil for controlled hypotension in endoscopic sinus surgery.Methods Eighty patients undergoing endoscopic sinus surgery were enrolled in the study.Patients were randomized into two groups of 40 to receive gastrodin （Group G） or remifentanil （Group R） infusion.Two groups were administered with propofol of 2 mg/kg to induce anaesthesia, which was maintained using sevoflurane.Group R received a continuous infusion of remifentanil titrated between 3 and 4 ng/mL using target-controlled infusion, whereas Group G received an i.v.gastrodin bolus of 2 mg/kg followed by a 20 mg/kg continuous infusion to maintain a mean arterial pressure （ MAP） between 60 and 70 mmHg.Haemodynamic variables, surgical conditions, postoperative pain, and adverse effects, such as postoperative nausea and vomiting （ PONV） and shivering were recorded.Results Controlled hypotension was well maintained in both groups.MAP and heart rate were higher in Group R than Group G after operation（P〈0.05）.Surgical conditions scores were not different between two groups.Postoperative pain scores were significantly lower in Group G than Group R （P〈0.05）.Shivering and the use of antiemetic and analgesic drugs were also less frequent in Group G than Group R （P〈0.05）.Conclusions Both gastrodin and remifentanil when combined with sevoflurane provides adequate controlled hypotension and proper surgical conditions for endoscopic sinus surgery.However, patient administered gastrodin has a more favourable postoperative course with better analgesia and less shivering and PONV.