摘要
目的观察异氟醚麻醉下瑞芬太尼控制性降压的效果、术野质量及对应激反应的影响。方法40例ASAⅠ-Ⅱ级择期鼻内镜手术患者,随机分为瑞芬太尼组(R组)及硝普钠组(F组)控制性降压。对比两组麻醉前及控制性降压期间血压、心率、血糖、皮质醇浓度及术野质量。结果各组控制性降压期间收缩压、平均动脉压均低于麻醉前(P<0.01)。R组控制性降压期间收缩压及平均动脉压、心率值均低于F组(P<0.05)。趋势图显示R组血压、心率均较F组平稳。R组术野质量明显好于F组(P<0.01)。各组控制性降压期间与麻醉前对比血皮质醇值均低(P<0.01),血糖值比较无统计学意义(P>0.05)。结论鼻内镜手术中瑞芬太尼控制性降压可达理想的降压效果,术野质量高,有效抑制了术中应激反应。
Objective To investigate the effects, surgical field quality and influence in the stress response of controlled hypotension induced by remifentanil with anesthesia of isoflorane during endoscopic sinus surgery. Methods Forty patients with ASA grade Ⅰ - Ⅱ undergoing selective endoscopic sinus surgery, were randomly assigned into remifentanil group （R group） and sodium nitroprusside group （F group）. Remifentanil[0.3 - 0- 8 μg/（kg·min） ] and sodium nitroprusside [0.5 - 3 μg/（kg·min]were respectively used in group R and group F to keep mean arterial pressure between 60 and 80 mmHg. The blood pressure, MAP and HR in two groups were recorded before anesthesia and during controlled hypotension. Surgical field quality was also determined during controlled hypotension. Blood glucose and cortisol were recorded before anesthesia （T1）, before surgery（T2 ） and during controlled hypotension （T3）, respectively. All data were analyzed with SPSS11. 2. Results SBP, MAP in two groups during controlled hypotension were lower than those before anesthesia（P 〈 0.01）. SBP, MAP, HR during controlled hypotension in group R were lower than those in group F （P〈0.05）. Compared with group F, surgical field quality in group R were significantly better （P〈0.01）during controlled hypotension. Blood glucose and cortisol level at T1, T2 and T3 were not significantly different between the two groups with convariance analysis. Blood glucose level at T3 was not significantly different compared with T1 and T2, but cortisol was lower（P〈 0.01）. The trend curves showed that the blood pressure and heart rate were stable in group R than those in group F. Conclusion Compared with sodium nitroprusside, controlled hypotension induced by remifentanil could achieve satisfactory effect with anesthesia of isoflorane and better surgical field quality, and inhibit the stress response.
出处
《山西医科大学学报》
CAS
2007年第5期447-450,共4页
Journal of Shanxi Medical University
关键词
麻醉
瑞芬太尼
控制性降压
鼻内镜手术
anesthesia
remifentanil
controlled hypotension
endoscopic sinus surgery
