瑞芬太尼联合异丙酚控制性降压用于鼻内窥镜手术观察.docVIP

瑞芬太尼联合异丙酚控制性降压用于鼻内窥镜手术观察 　;作者：王强 冯伟 【关键词】; 瑞芬太尼；,硝普钠；,控制性降压；血气分析；,鼻内窥镜 　　摘; 要; 目的：研究异丙酚和瑞芬太尼联合应用行控制性降压用于鼻内窥镜手术的可行性。方法 ASAⅠ～Ⅱ级择期鼻内窥镜手术病人40例，随机分两组，每组20例，Ⅰ组为瑞芬太尼组，Ⅱ组为硝普钠组。Ⅰ组术中静脉泵入瑞芬太尼以0.20mu;g/(kg#12539;min)～0.50mu;g/(kg#12539;min)1，Ⅱ组静脉泵入0.01%硝普钠0.1mu;g/(kg#12539;min)～1mu;g/(kg#12539;min)控制性降压，分别在控制性降压前(T1)，降压后10min(T2)、40min(T3) 及停降压后10min(T4)，作血气分析,记录降压期间血流动力学参数，记录瑞芬太尼、硝普钠总用量和控制性降压时间，计算瑞芬太尼、硝普钠输注速度。结果：两组血压均安全降至60mmHg～65mmHg；Ⅰ组血气分析大致正常，Ⅱ组血气分析呈轻度酸血症。Ⅰ组降压期间心率降低Ⅱ组则增快(Plt;0.05)。结论：瑞芬太尼联合应用异丙酚控制性降压有效减少了术中出血，安全有效，为行鼻内窥镜手术提供了良好的术野条件。 　　关键词; 瑞芬太尼； 硝普钠； 控制性降压；血气分析； 鼻内窥镜 　　Abstract; Objective：To determine feasibility of controlled hypotension induced by remifentanil, combined with propofol,compared with nitroprusside during endoscopic sinus surgery.Methods Forty patients (ASAⅠ～Ⅱ) undergoing tympanoplasty and anesthetized with 2.0mg/kg～2.5 mg/kg propofol iv followed by a constant infusion of 50mu;g(kg#12539;min)～80mu;g(kg#12539;min), were randomly assigned in two groups.Group Ⅰ was; received 1mu;g(kg#12539;min) remifentanil iv followed by a continuous infusion of; 0.25 to 0.5mu;g(kg#12539;min) for controlled hypotension, Group Ⅱ was; received nitroprusside iv,combined with fentanil iv for controlled hypotension. Record all data of HR，MAP ,blood gas at four points: before hypotension(T1), after hypotension 10min(T2), after hypotension 40min (T3) , after stopping hypotension 10min(T4). Results： Controlled hypotension was achieved at the target pressure of 60-65 mmHg for remifentanil, nitroprusside respectively. Controlled hypotension was sustained in all two groups throughout surgery。 Nitroprusside decreased pH and increased PaCO2 ,HR. There were no postoperative complications in any of the groups.Conclusions Remifentanil combined with propofol enabled controlled hypotension, provided good surgical conditions for endoscopic sinus surgery operation without use of a potent hypotensive agent. 　　Key wordRemifentanil; Sodium Nitroprusside; Controlled hypotensio;Blood gas ; Endoscopic