临床医学论文-舒芬太尼在鼻内镜手术中控制性降压的临床观察.docVIP

临床医学论文-舒芬太尼在鼻内镜手术中控制性降压的临床观察 【摘要】? 目的：观察舒芬太尼用于静吸复合全麻时在鼻内镜手术中行控制性降压的效果。方法：42例ASAⅠ_Ⅱ级择期鼻内镜手术患者随机分为舒芬太尼组(以舒芬太尼为镇痛药诱导且在术中复合异氟醚、丙泊酚维持麻醉并调控BP)和硝普钠组(以芬太尼为镇痛药诱导且在术中以丙泊酚、异氟醚维持并加用硝普钠调控BP)，每组21例。记录两组不同时间点的收缩压、平均动脉压、HR、呼气末异氟醚浓度、皮质醇浓度及术野质量。结果：两组控制性降压期间收缩压、平均动脉压均低于麻醉前(P001)。舒芬太尼组控制性降压期间收缩压、平均动脉压、HR均低于硝普钠组(P005)，术野质量明显好于硝普钠组(P001)。皮质醇浓度在控制性降压期间明显低于麻醉前(P001)，组间同时间点比无统计学意义。结论：鼻内镜手术中以舒芬太尼用于静吸复合全麻时控制性降压可达理想的降压效果，术野质量高，可有效抑制术中应激反应。 【关键词】? 舒芬太尼 控制性降压 鼻内镜手术 ??? Yuebei Peoples Hospital,Shaoguan512026，China)［Abstract］Objective： To investigate the effect of sufentanil in controlled hypotension during endoscopic sinus surgery. Methods： Forty_two patients with ASA grade Ⅰ_Ⅱ underwent selective endoscopic sinus surgery were randomly assigned into sufentanil group and sodium nitroprusside group. Anesthesia was induced with sufentanil as narcotic analgesics and maintained with sufentanil， isoflurane， propofol to control BP in the sufentanil　group， but induced with fentunyl and maintained with isoflurane， propofol combined sodium nitroprusside to control blood pressure in the sodium nitroprusside group. Systolic pressure， mean arterial pressure， heart rate， endtidal isoflurane concentration， cortisol level， surgical field quality between two groups were recorded in different times. Results： Systolic pressure， mean arterial pressure between two groups during controlled hypotension were lower than those before anesthesia(P001). Systolic pressure， mean arterial pressure and heart rate during controlled hypotension in the sufentanil group were lower than those in the sodium nitroprusside group(P005). Compared with the sodium nitroprusside group， the surgical field quality in the sufentanil group were significantly better during controlled hypotension(P001). The cortisol levels during controlled hypotension were significantly lower compared with before anesthesia between two groups(P001). Conclusion： The controlled hypotension induced by isoflurane can achieve satisfactory effect and better