CAJ | 학술논문

目的对比评价内窥镜下鼻手术应用瑞芬太尼或盐酸尼卡地平控制性降压麻醉的效果.方法 30例ASAI-Ⅱ级择期行内窥镜下鼻手术病人,年龄15～63岁,随机分为瑞芬太尼组(R组)和盐酸尼卡地平(N组),每组15例.两组病人麻醉诱导及维持方法相同.R组以瑞芬太尼2μg/kg静注,0.1～0.5μg/(ks·min)维持;N组以盐酸尼卡地平1μg/kg静注,0.5～1μg/(kg·min)维持.桡动脉穿刺直接动脉测压.两组均将平均动脉压(MAP)降至50-70 mm Hg(1 mm Hg=0.133 kPa)至手术结束.观察两组病人术中平均动脉压、中心静脉压、心率变化、失血量的差异.结果降压期间R组的心率显著低于降压前(P＜0.01),而N组显著高于降压前(P＜0.05).N组降压5、10、15 min时中心静脉压显著低于降压前(P＜0.05),R组与降压前相比差异无统计学意义.结论瑞芬太尼可有效地用于内窥镜下鼻手术控制性降压;与盐酸尼卡地平相比,具有减慢心率、降压平稳、对中心静脉压影响小等优点.
목적 대비평개내규경하비수술응용서분태니혹염산니잡지평공제성강압마취적효과.방법 30례ASAI-Ⅱ급택기행내규경하비수술병인,년령15～63세,수궤분위서분태니조(R조)화염산니잡지평(N조),매조15례.량조병인마취유도급유지방법상동.R조이서분태니2μg/kg정주,0.1～0.5μg/(ks·min)유지;N조이염산니잡지평1μg/kg정주,0.5～1μg/(kg·min)유지.뇨동맥천자직접동맥측압.량조균장평균동맥압(MAP)강지50-70 mm Hg(1 mm Hg=0.133 kPa)지수술결속.관찰량조병인술중평균동맥압、중심정맥압、심솔변화、실혈량적차이.결과 강압기간R조적심솔현저저우강압전(P＜0.01),이N조현저고우강압전(P＜0.05).N조강압5、10、15 min시중심정맥압현저저우강압전(P＜0.05),R조여강압전상비차이무통계학의의.결론 서분태니가유효지용우내규경하비수술공제성강압;여염산니잡지평상비,구유감만심솔、강압평은、대중심정맥압영향소등우점.
Objective To compare the effects of remifentanil and nicardipine for controlled hypotension during endoscopic nasal sinus surgery. Methods Thirty ASA Ⅰ or Ⅱ patients aged 15 -63 years undergoing endoscopic nasal sinus surgery were randomly divided into 2 groups(n = 15 each) : group R control and group N controlled hypotension. Anesthesia induction and maintenance in both groups were the same method. In group R, intravenous administration of remifentanil :2 μg/kg, followed by infusion of remifentanil 0.1 - 0. 5 μg/(kg · min) for controlled hypotension, and the patients of group N received nicardipine 1 μg/kg,followed by nicardipine 0.5 -1 μg/(kg · min). The target of controlled hypotension was fixed at MAP 50 -70 mm Hg,which was maintained the end of surgery. The changes of MAP,CVP and HR in two groups were recorded during surgery. Results HR was significant reduced in R group compared with that before (P＜0.01), which was significant increased in N group during controlled hypotension (P＜0.05). CVP value during 5 - 15 min controlled hypotension was significantly lower than that before in group N (P＜0.05) ,but not in group R. Conclusions Remifentail could be used effectively for controlled hypotension during endoscopic nasal sinus surgery with less influence on CVP.