摘要
目的观察瑞芬太尼复合异氟烷在神经外科手术中行控制性降压的效果，比较瑞芬太尼和硝普钠对患者肾素-血管紧张素-醛固酮系统（RAAS）的影响。方法择期行控制性降压的手术患者40例，ASA Ⅰ～Ⅱ级，气管插管后，控制呼气末异氟烷浓度为1．2％±0．2％。按降压方法将患者随机分为两组，每组20例，均使平均动脉压（MAP）降低至基础值的60％～70％（目标血压）。Ⅰ组：从1．0μg·kg^-1·min^-1的速度开始给予硝普钠，每隔30s增加0．5μg·kg^-1·min^-1直至血压达到目标血压。Ⅱ组：从（0．15～0．2）μg·kg^-1·min^-1的速度开始给予瑞芬太尼，每隔30s增加0．05μg·kg^-1·min^-1直至达到目标血压。在麻醉前（T0）、控制性降压前（T1）、控制性降压后5min（T2）、控制性降压后30min（T3）及控制性降压结束后20min（T4）记录MAP、HR、CVP，同时测定血中肾素、血管紧张素Ⅱ、醛固酮含量。由术者在不知道控制性降压方式的情况下评估术野质量。结果Ⅰ组T2～4的HR较T0和T1增加；Ⅱ组T2～4的HR较T0和T1减慢，也较Ⅰ组T2-4的HR慢；Ⅰ组T4的MAP、CVP较T1高，也高于Ⅱ组T4的MAP、CVP（P〈0．05或0．01）。Ⅰ组T2～4肾素、血管紧张素Ⅱ、醛固酮含量高于T0和T1，也高于Ⅱ组相应时点三种激素的含量（P〈0．05）。而Ⅱ组三种激素的含量在T0～4未见明显变化（P〉0．05）。Ⅱ组的出血量较Ⅰ组少，6点刻度表和VAS评分均低于Ⅰ组（P〈0．05）。结论与硝普钠相比，瑞芬太尼复合异氟烷控制性降压降压过程平稳，为手术提供更清晰的术野，并在控制性降压期间抑制RAAS。
Objective To investigate the effect of remifentanil-isoflurane-induced controlled hypotension on renin-angiotensin-aldosterone system of patients undergoing neurosurgery, compared with that induced by sodium nitroprusside （ SNP ） and isoflurane. Methods Forty patients, with ASA Ⅰ～Ⅱ, were enrolled into the study. Anesthesia was maintained by inhalation of isoflurane with end-tidal concentration of about 1.2 % ± 0.2%. Patients were randomly assigned into two groups （ n = 20）, receiving continuous intravenous infusion of SNP （ group Ⅰ） or remifentanil （ group Ⅱ） to control MAP to a level of 60 % - 70% of baseline. HR, MAP and CVP were measured, and plasma levels of rennin （PRA） , angiotensin （AT-Ⅱ） and aldosterone （ALD） were detected before anesthesia （ T0 ） , before controlled hypotension （ T1 ） , 5 min （ T2 ） and 30 min （ T3 ） after hypotension, and 20 min after termination of controlled hypotension （ T4 ）. Results HR got quicker in group Ⅰ, and slower in group Ⅱ （ P 〈 0.05 ） during controlled hypotension. MAP and CVP increased significantly at T4 in group Ⅰ, but changed no much at T4 in group Ⅱ, compared with that at T0. Plasma levels of PRA, AT-Ⅱ and ALD were significantly increased in group Ⅰ, but didn＇t change markedly in group Ⅱ during controlled hypotension. Blood loss from the surgical field was less in group Ⅱ than in group Ⅰ. Conclusion Compared with SNP, remifentanil combined with isoflurane-induced controlled hypotension is well performed, maintains RAAS at a stable status, and provides an ideal operating condition for neurosurgery.
出处
《国际麻醉学与复苏杂志》
CAS
2007年第1期24-27,47,共5页
International Journal of Anesthesiology and Resuscitation
