雷米芬太尼-七氟醚静吸复合麻醉用于鼻内镜手术控制性降压

目的 探讨雷米芬太尼-七氟醚静吸复合麻醉用于鼻内镜手术控制性降压的安全性和可行性。方法 40例鼻内镜手术患者随机均分为非控制性降压组（Ⅰ组）和控制性降压组（Ⅱ组），两组麻醉诱导相同。Ⅰ组 麻醉维持为芬太尼、丙泊酚，不施行控制性降压。Ⅱ组麻醉维持为雷米芬太尼（0.1～0.2）μg/（kg·min ）]、吸入1%-3%七氟醚，维持MAP在50-70mmHg。记录手术开始前即刻（T0）、手术10min（T1）、手术30min（ T2）、手术结束后10min（T3）的MAP和HR，观察比较两组术中出血量、手术时间、苏醒时间、尿量及术后并 发症。结果 与T0比较，Ⅱ组T1、T2时HR减慢（P〈0.05）、MAP显著下降（P〈0.01），T3时回升，T1、T2时Ⅱ 组较Ⅰ组HR减慢（P〈0.05），MAP显著下降（P〈0.01）。Ⅱ组比Ⅰ组手术出血量明显减少，手术时间缩短，苏 醒时间缩短（P〈0.01）。结论 雷米芬太尼-七氟醚静吸复合麻醉用于鼻内镜手术控制性降压快速平稳，复压 迅速，可明显减少出血量，缩短手术时间，安全可行。

Remifentanil-Sevoflurane Inhalation Anesthesia-induced Hypotension for Endoscopic Sinus Surgery

Objective To investigate the remifentanil-Sevoflurane inhalation anesthesia-induced hypotension for endoscopic sinus surgery for the safety and feasibility. Methods 40 cases of endoscopic sinus surgery were randomly divided equally for non-controlled blood pressure group（group Ⅰ ） and controlled hypotension group（group Ⅱ ）, both groups of midazolam, fentanyl, propofol,vecuroninm. Group Ⅰ anesthesia to be maintained as fentanyl, propofol. Group Ⅱ remifentanil anesthesia maintained at 0.1-0.2 μ g/（kg·min）, inhalation of 1%-3% sevoflurane to maintain MAP at 50-70mmHg. Recorded MAP and HR at the start of surgery（T0）,surgical 10min（T1）,surgical 30min（T2）,after surgery 10min （T3）. Compared two groups of blood loss, operative time,recovery time, urine output,postoperative complications. Intraoperative monitoring of ECG,invasive MAP,HR and SPO2,surgical blood gas analysis after the 30min. Results Compared with T0,the HR slowing in group Ⅱ at TI,T2 （P〈0.05）,MAP decreased significantly（P〈0.01 ）, at T3 rises again, at T1,T2, compared with group Ⅰ ,group Ⅱ HR slowing（P〈0.05）, MAP decreased significantly（P〈0.01 ）. Compared with group Ⅰ , group Ⅱ surgery significantly reduced the amount of bleeding, operative time（P〈 0.01 ）,recovery time（P〈0.01 ）. Conclusion Remifentanil- Sevofluranc inhalation anesthesia induced hypotension in endoscopic sinus surgery for the rapid and smooth, complex pressure quickly, can significantly reduce the amount of bleeding, shorter operative time, feasible and safe.