瑞芬太尼在脊柱手术中对患者血压及心率的影响.DOCVIP

临床医学论文-瑞芬太尼在脊柱手术中对患者血压及心率的影响 ????????????? 作者：康吉龙，李仁淑，周艳梅??? ［摘要］ ［背景］ 观察瑞芬太尼在脊柱手术期间对患者血压及心率的影响. ［病例报告］ 选择40例择期手术患者，随机分为对照组和观察组，每组各为20例.麻醉维持期给两组患者静脉注入异丙酚6mg/（kg?h），仙林每30min4mg，吸入20～30mL/L安氟醚，观察组患者追加给予静脉注入瑞芬太尼0.05～0.10μg/（kg?min）.观察记录手术前及手术开始后5，15，30，45min时患者收缩压及心率.与麻醉前比较，对照组患者麻醉期间收缩压及心率均明显升高，而观察组患者均显著下降，两者间差异有统计学意义. ［结论］ 瑞芬太尼可有效地降低手术期间患者的血压及心率，减少手术视野出血，保持血液动力学指标稳定. ??? ［关键词］? 芬太尼;脊柱;麻醉，全身 ??? ABSTRACT:BACKGROUND To study the effects of remifentanil on BP and HR during spinal column operation.CASE REPORTS40patients were randomly divided into two groups，control and observation with20cases each，both of them were administrated with propofol6mg/（kg?h），vecuronium bromide per30min4mg，enflurane20～30mL/L during anesthesia.And in observation group remifentail was injected intravenously0.05～0.10μg/（kg?min）.To record the BP and HR15，30，45，60min in both groups.BP，HR were higher during anesthesia than before anesthesia significantly in control group;BP，HR were lower during anesthesia than before anesthesia significantly in observation group.DISCUSSION Remifentail take from the BP，HR effectively during operation，reduce the blooding，ensure the operative field clean and maintain the hemodynamics tranquilization，so as to the operation go with a swing. ??? Key words:phentanyl;spine;anesthesia，general ??? 脊柱手术时患者出血量较多，故麻醉期间需要控制患者血压，以减少术中出血，保证手术视野清晰度.本观察组利用瑞芬太尼有效地控制了20例脊柱手术患者手术期间的血压及心率，取得了满意的效果. ??? 1 资料与方法 ??? 1.1 一般资料? 选择择期脊柱手术患者40例，年龄为32～65岁，体重为40～85kg，ASA分类为Ⅰ，Ⅱ级，心、肺、肝、肾功能及血压均无异常;随机分为对照组及观察组，每组各为20例，两组患者性别、年龄及体重间具有可比性. ??? 1.2 麻醉方法? 麻醉前用药:均于麻醉前30min给两组患者肌肉注射苯巴比妥钠20μg/kg和阿托品7～10μg/kg.麻醉诱导期:依次静脉注射给予咪唑安定8μg/kg，芬太尼3.0μg/kg，依托咪酯0.30mg/kg及仙林0.10～0.15mg/kg，进行气管内 插管.麻醉维持期:均给予两组患者静脉持续注入异 丙酚6.0mg/（kg?h），仙林每30min4.0mg并吸入20～30mL/L安氟醚，观察组患者追加静脉持续注入瑞芬太尼0.05～0.10μg/（kg?min）. ??? 1.3 监测? 应用自动测血压仪持续监测麻醉期间患者的血压及心率，记录麻醉前及手术开始后5，15，30，45min时的收缩压及心率. ??? 1.4 统计学处理? 对所有数据采用SPSS10.0统计学软件进行分析，数据以均数±标准偏差（x±SD）表示，采用配对样本t检验. ??? 2 结果 ??? 对照组病人手术开始后5min收缩压明显升高，与麻醉前比较差异有统计学意义（P0.05）;观察组病人手术开始后各时间收缩压显著下降，分别与对照组各