摘要
目的:观察瑞芬太尼(Remifentanil)控制性降压在颅内动脉瘤合并高血压患者行介入血管内栓塞术中的临床价值。方法:30例颅内动脉瘤患者,根据术前是否患合并高血压分为对照组(C组)与高血压组(H组),每组15例。麻醉诱导均采用静脉注射丙泊酚1.5～2mg/kg、瑞芬太尼1μg/kg、维库溴铵0.1mg/kg。麻醉维持:丙泊酚3～5mg(/kg.h),瑞芬太尼0.2～0.4μg(/kg.min),吸入异氟醚0.8%～1.2%,间断静脉注射维库溴铵0.06mg/kg维持肌松。需要控制性低血压时,加快瑞芬太尼的泵注至0.8μg(/kg.min)。有创动脉压监测,记录入室时、诱导后、插管时、颅内动脉瘤栓塞前、栓塞后、拔管时各时点的血流动力学数据。结果:麻醉诱导后2组患者血压及心率均较基础值明显降低(P<0.05),C组在手术期间血压、心率均稳定,而H组的血压常于栓塞前开始升高,需用硝普钠降压且术中血压升高的发生率高于N组(P<0.05)。结论:瑞芬太尼控制性降压对于颅内动脉瘤未合并高血压的患者安全有效,但是对于颅内动脉瘤合并高血压患者行控制性降压在应用瑞芬太尼的同时需其他药物的辅助。
Objective：To investigate the clinical efficacy of deliberate hypotension with remifentanil in endovascular treatment of intracranial aneurysms. Methods.A total of 30 cases of intracranial aneurysms,were divided according to the condition of combined with hypertension,into control group（Group C） and hypertension group（Group H）,each with 15 cases. Two groups adopted induction of anesthesia in patients with intravenous propofol 1.5-2mg/kg,remifentanil 1 μg/kg,vecuronium 0.1mg/kg. Maintenance of anesthesia ： propofol 3-5mg/（kg· h ） and remifentanil 0.2 - 0.4 μ g/（ kg· min）, and intermittent intravenous injection of vecuronium 0.06mg/kg maintained muscle relaxation. When controlled hypotension was needed,the infusion of remifentanil to accelerated 0.8μg/（kg·min）. Heart rate and blood pressure were recorded at baseline,after anesthesia induction,on tracheal intubation, before intracranial aneurysm embolism, after intracranial aneurysm embolism and extubation. Results ：After induction of anesthesia, there were obvious decline in blood pressure and heart rate in both group（P〈0.05 ）. The BP and HR of Group C were stable in the whole progress of operation, while BP Group H often increased before intracranial aneurysm embolism and needed controlled hypotension with sodium nitroprusside and incidence of hypertension was higher than that of N group（P〈0.05）. Conclusion：Controlled hypotension with remifentanil was safe and pratical for non-hypertension patients,but it was not enough only with remifentanil for hypertension patients,which needed other drug such as sodium nitroprusside.
出处
《重庆医科大学学报》
CAS
CSCD
2008年第4期507-509,共3页
Journal of Chongqing Medical University
关键词
瑞芬太尼
高血压病
颅内动脉瘤
控制性降压
Remifentanil
Hypertension
Intracranial aneurysm
Controlled hypotension
