摘要
目的观察异氟醚麻醉下雷米芬太尼控制性降压的效果、术野质量以及对应激反应的影响。方法40例ASA I-Ⅱ级择期鼻内镜手术患者，随机分为雷米芬太尼组和硝普钠组控制性降压。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。结果两组控制性降压期间平均动脉压均低于麻醉前（P〈0．01）。雷米芬太尼组控制性降压期间平均动脉压、心率值均低于硝普钠组（P〈0．05）。雷米芬太尼组术野质量明显好于硝普钠组（P〈0．05）。两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）。结论鼻内镜手术中雷米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 on 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 sodi- um nitroprusside group（ F group）. Remifentanil [0.3 - 0. 81μg/（ kg · min） ] and sodium nitroprusside [0.5-3μg/（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 controlled hypotension （T1）, during controlled hypotension （T2） and before controlled hypotension （1-3）, respectively. Results MAP in two groups during controlled hypotension were lower than those before anesthesia （P 〈0. 01）, 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 1-2, but cortisol was Iower（P 〈0. O1 ）. 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
《湖北民族学院学报（医学版）》
2008年第1期23-25,28,共4页
Journal of Hubei Minzu University(Medical Edition)
关键词
麻醉
雷米芬太尼
控制性降压
鼻内镜手术
Anesthesia
Remifentanil
Controlled Hypotension
Endoscopic Sinus Surgery
