CAJ | 학술논문

目的观察瑞芬太尼联合七氟醚在脊椎手术中控制性降压的临床效果.方法选择行脊椎手术的ASA Ⅰ～Ⅱ级的患者40例,随机分为瑞芬太尼组(Ⅰ组)和硝酸甘油组(Ⅱ组),每组20例.所有患者均采用气管内全麻,吸入七氟醚维持麻醉,手术切皮前实施控制性降压,术中调整瑞芬太尼和硝酸甘油的剂量,维持平均动脉压在60～65 mmHg之间,手术结束时停止控制性降压.记录两组患者的平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、脊椎手术节段数、手术时间、术中出血量和苏醒时间.结果实施控制性降压后两组病人的MAP均能达到预定目标.降压期间Ⅰ组出现心率减慢;Ⅱ组出现心率增快.降压期间两组CVP均低于基础值,Ⅱ组比Ⅰ组更低.Ⅰ组术中出血量明显少于Ⅱ组.Ⅰ组停止降压后10min血压恢复至基础值;Ⅱ组停止降压后20 min血压仍低于基础值.结论在脊椎手术中选用瑞芬太尼联合七氟醚控制性降压效果良好.与硝酸甘油降压相比较,瑞芬太尼降压具有术中出血量少、术后血压恢复快的优点.
목적 관찰서분태니연합칠불미재척추수술중공제성강압적림상효과.방법 선택행척추수술적ASA Ⅰ～Ⅱ급적환자40례,수궤분위서분태니조(Ⅰ조)화초산감유조(Ⅱ조),매조20례.소유환자균채용기관내전마,흡입칠불미유지마취,수술절피전실시공제성강압,술중조정서분태니화초산감유적제량,유지평균동맥압재60～65 mmHg지간,수술결속시정지공제성강압.기록량조환자적평균동맥압(MAP)、심솔(HR)、중심정맥압(CVP)、척추수술절단수、수술시간、술중출혈량화소성시간.결과 실시공제성강압후량조병인적MAP균능체도예정목표.강압기간Ⅰ조출현심솔감만;Ⅱ조출현심솔증쾌.강압기간량조CVP균저우기출치,Ⅱ조비Ⅰ조경저.Ⅰ조술중출혈량명현소우Ⅱ조.Ⅰ조정지강압후10min혈압회복지기출치;Ⅱ조정지강압후20 min혈압잉저우기출치.결론 재척추수술중선용서분태니연합칠불미공제성강압효과량호.여초산감유강압상비교,서분태니강압구유술중출혈량소、술후혈압회복쾌적우점.
Objective To observe the clinical effect of controlled-hypotension by comhination of Remifentanil and Sevoflurane in patients undergoing spinal surgery.Mtthoda 40 cases of ASA Ⅰ～Ⅱpatients who received surgery spinal surgery were chosen,and randomized into two groups:Remifentanil group(Ⅰ group)and Glonoine group(Ⅱ group),each 20 people.All patients received endotracheal anesthesia and inhale Sevoflurane to maintain the anesthesia.Implemented the controlled-hypotension before skin exciding,adjusted the dosage of Remifentanil and Glonoine and maintain the MABP[mean arterial blood pressure)at 60～65mmHg during the operation,and stop the controlled-hypotension at the end of the operations.Recorded the two group's MAP,HR,CVP,the number of spinal segment,operation time,the amount of surgical bleeding,and the time of vivification.Results two groups'patient can achieve the MAP target after implementing the controlled-hypotension.The HR slowed down in Ⅰ group and increased in Ⅱgroup during the time of controlled-hypotension.Two groups'CVP were lower than the baseline,and the Ⅱgroup were lower than the Ⅰ group.After stopping controlled-hypotension,the BP get back to the baseline10min later in the Ⅰ group,while it still lower than the baseline in the Ⅱ group 20min later.Conclusion The controlled-hypotension by combination of Remifentanil and Sevoflurane in patients undergoing spinal surgery has good results.In compare with Glonoine,the Remifentanil has the advantage of less bleeding and rapid BP recovery.