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1.
尼莫地平用于颅脑术中控制性降压的初步探讨   总被引:4,自引:0,他引:4  
报道20例颅脑手术中应用国产尼莫地平控制性降压的初步体会。结果表明,颅脑手术中静滴0.02%尼莫地平,初速为600~800ug/min,可使平均动脉压降至并维持在7.3~8.0kPa,降压维持时间30~60分钟,尼莫地平总量4~12mg。降压期间收缩压下降31.6%~35.6%,舒张压下降36.1%~41.9%。平均动脉压下降33.0%~37.7%,以舒张压下降幅度最大,降压效果良好,减少了术中出血。停药后15~30分钟血压自动回升到降压前水平,未发生“反跳性”血压升高。  相似文献   

2.
目的 探讨右美托咪啶在全麻鼻内镜手术控制性低血压中应用的安全性及有效性.方法 对60例择期全麻下行鼻内镜手术患者按随机数字表法随机分为两组(每组30例),采用硝普钠(N组)、右美托咪啶(D组)行控制性低血压,维持平均动脉压( MAP)在60 mm Hg~70 mm Hg(1 mm Hg=0.133 kPa).记录诱导前5min(T0)、手术开始后30 min(T1及拔管即刻(T2)时的心率(HR)、MAP及达标时间、手术时间、降压持续时间、拔管时间、出血量及尿量,对术野质量和苏醒期清醒镇静程度进行平定并观察有无副作用.结果 两 组患者年龄、体重、性别比、手术时间、控制降压持续时间组间比较,差异无统计学意义(P>0.05).所有患者术中MAP均能维持在目标范围.两组患者T0时点MAP、HR组间比较,差异无统计学意义(P >.05);降压达标时间D组(16.7±3.7) min较N组(10.1±1.8) min慢(P<0.05);T2、T1时点与T0时点比较,N组HR(105+7)、(82±5)次/min较(78±6)次/min明显增快(P<0.05),D组HR(74±7)、(69±8)次/min较(79±8)次/min明显减慢(P<0.05);组间比较,T2、T1时点N组HR(105±7)、(82±5)次/min明显高于D组(74±7) 、(69±8)J/min(P<0.05).N组拔管时出现反跳性高血压,D组拔管时MAP(84+10) mm Hg仍低于诱导前水平(95±8) mm Hg(P<0.05).D组术野质量评定(scores of surgical field quality,SSFQ)(1.2±0.4)分优于N组的(1.9±0.5)分(P<0.05);N组的拔管时间(14.5±1.8) min要短于D组的(16.5±2.7)min(P<0.05);N组苏醒期清醒镇静评分(1.5±A5)分优于D组的(2.0±0.3)分(P<0.05),但N组有6例出现术后躁动;D组出血量(111±45) ml较N组的(191±43)ml少(P<0.05),D组尿量(390±105) ml较N组的(230±83) ml多(P<0.05).所有患者术后随访无术中知晓、呼吸抑制等麻醉并发症发生.结论在全麻鼻内镜手术中应用右美托咪啶行控制性低血压安全可行,能提供更好的术野质量,同时副作用更少,值得推广应用.  相似文献   

3.
4.
AIM: To evaluate the efficacy of magnesium sulfate(MGS) in comparison with remifentanil for induction of relative hypotension in posterior fusion of spine(PSF).METHODS: In this randomized clinical trial, 40 patients with the American Society of Anesthesiologists Ⅰ and Ⅱ physical status undergoing lumbar PSF were randomized to receive remifentanil(REM) 0.15 μg/kg or MGS 50 mg/kg for controlled hypotension. The administering anesthesiologist was blinded to the medication. Continuous infusion was maintained at a fixed volume rate to deliver precalculated doses of either study drugs. All other aspects of anesthesia and surgery were similar in the two groups. The target mean arterial pressure(MAP) range used in this study was 60-70 mm Hg. In the course of surgery, the hemodynamic variables, volumeof blood loss, urine output, fluid intake and surgeon's satisfaction were recorded. Data was analyzed with SPSS version 13.0 and P values less than 0.05 were considered significant.RESULTS: Twenty patients in the MGS group and 19 patients in the REM group were studied. There was no difference between the two groups in the hemodynamic variables, blood loss, urine output, fluid requirement and surgeon's satisfaction for exposure. The target MAP was achieved in 75% of Mg and 58% of remifentanil groups. Although a higher number of patients in the REM group required nitroglycerin(42.1%) to reach the target MAP than those in the MGS group(25%), this difference was not statistically significant(P = 0.32).CONCLUSION: Our findings showed that in patients undergoing lumbar PSF surgery, remifentanil and MGS have a similar hypotensive effect and comparable amount of blood loss without any significant adverse effects.  相似文献   

5.
BackgroundThis study was designed to evaluate the efficacy of dexmedetomidine as a hypotensive agent in comparison to sodium nitroprusside in scoliosis surgery.MethodForty patients ASA I or II aged (12–16) year scheduled for scoliosis surgery were randomly assigned to receive either dexmedetomidine 1 μg/kg over 10 min before induction of anesthesia followed by 0.2–0.5 μg/kg/h infusion during maintenance (DEX group) or sodium nitroprusside 1–10 μg/kg/min infusion after induction of anesthesia (SNP group) to maintain mean arterial blood pressure between (60–65 mmHg). Mean arterial pressure (MAP), heart rate (HR), cardiac index (CI), systemic vascular resistance index (SVRI) and stroke index (SI) were recorded. The two groups were compared with reference to reversibility of hypotensive state, intraoperative blood loss and transfusion requirement.ResultsDexmedetomidine administration resulted in significant reduction in MAP, HR and CI. During the steady state hypotension SNP group showed significant increase in HR and CI compared to baseline and to DEX group (P < 0.05). SVRI was significantly lower during controlled hypotension in SNP group compared to DEX group (P < 0.001). Time to restoration of baseline MAP was longer with DEX group (10.21 ± 1.52 min) than SNP group (4.87 ± 0.86 min) (P < 0.001). Blood loss and transfusion requirement were significantly lower in DEX group than SNP group [1095.62 ± 128.9 6 ml versus 1287.50 ± 182.54 ml, P = 0.0013] and [855.42 ± 140.23 versus 1006.00 ± 154.66 ml, P = 0.0026], respectively.ConclusionDexmedetomidine is a safe and effective drug for controlled hypotension in scoliosis surgery. It may offer the significant advantage of reducing blood loss and transfusion requirement.  相似文献   

6.
目的 探讨控制性降压联合自体血回输技术应用于复杂脊柱外科大手术的临床效果及安全性. 方法 将40例脊柱外科大手术的患者用抽签法随机分为两组(每组20例):控制性降压联合自体血回输组(A组)和非自体血回输组(B组).A组全麻诱导后,术中用硝酸甘油行控制性降压,维持平均动脉压(mean arterial pressure,MAP)(65±5) mmHg(1mmHg=0.133 kPa),并用血液回输仪回收术野出血;B组未行自体血回输;两组术中血细胞比容(hematocrit,Hct)低于25%即输库血.两组术中连续监测心率(heart rate,HR)、MAP、心电图(electrocardiogram,ECG)和中心静脉压(central venous pressure,CVP).记录两组患者术中出血量、异体输血量及输血相关并发症,术前和术后24 h红细胞(red blood cell,RBC)、血红蛋白(hemoglobin,Hb)、Hct、血小板(platelet,PLT)及凝血酶原时间(prothrombintime,PT)、活化部分凝血酶原时间(activeated partial thromboplasting time,APTT)和纤维蛋白原(fibrinogen,FG). 结果 A组出血量(1 120±510) ml与B组(1 524±457) ml比较,差异有统计学意义(P<0.05);A组输异体血发生率(10%)显著少于B组(100%)(P<0.01);术后24 h两组患者RBC、Hb、Hct、PLT、PT、APTT和FG与术前比较差异有统计学意义(P<0.05),但都在正常范围内,两组间比较差异无统计学意义(P>0.05);两组均无肺水肿、心力衰竭及创面异常出血并发症. 结论 控制性降压复合术中自体血回输在复杂脊柱手术中的应用是安全可靠的,能明显减少出血量,减少甚至避免异体血输入.  相似文献   

7.
目的观察瑞芬太尼复合七氟醚控制性降压对神经外科手术患者脑氧代谢的影响。方法选择拟行控制性降压的神经外科手术患者60例,随机均分为三组:R1组为瑞芬太尼3ng/ml复合七氟醚组,瑞芬太尼效应室靶浓度设定为3ng/ml;R2组为瑞芬太尼6ng/ml复合七氟醚组,瑞芬太尼效应室靶浓度设定为6ng/ml;N组为硝普钠组。R1、R2组同时吸入七氟醚,控制七氟醚呼出气浓度为1MAC,N组泵注硝普钠的速率为1~3μg·kg-1·min-1。记录麻醉前10min(T0)、降压后10min(T1)、30min(T2)、停止降压10min(T3)、30min(T4)时的MAP和HR,采集相应时点的颈内静脉血和动脉血作血气分析,计算动脉血氧含量(CaO2)、颈内静脉球部血氧含量(CjvO2)、脑动-静脉血氧含量差(Da-jvO2)、脑氧摄取率(CERO2)。结果 T1~T4时R1、R2组,T1、T2时N组MAP明显低于T0时(P<0.01),T2时R2组MAP明显低于N组和R1组(P<0.05或P<0.01)。T1~T4时N组HR明显快于T0时和R1、R2组(P<0.01),T1~T3时R1、R2组HR明显慢于T0时,而T2时R2组HR明显慢于R1组(P<0.05或P<0.01)。T1~T4时三组CjvO2明显高于T0时(P<0.01),而Da-jvO2与CERO2明显低于T0时(P<0.01),T1、T2时R1、R2组CjvO2高于N组(P<0.05),而Da-jvO2与CERO2低于N组(P<0.05)。结论瑞芬太尼复合七氟醚控制性降压可降低神经外科手术患者的脑氧代谢,降压平稳迅速,HR缓慢,停止降压后无BP反跳现象,有利于围术期脑保护。  相似文献   

8.
目的观察右旋美托咪啶分别复合七氟醚及丙泊酚对全麻患者苏醒的影响。方法选择全麻下行腹部手术患者80例,随机双盲分为4组:七氟醚+生理盐水组(S组)、丙泊酚+生理盐水组(P组)、七氟醚+右旋美托咪啶组(SD组)及丙泊酚+右旋美托咪啶组(PD组)。右旋美托咪啶用生理盐水稀释成4μg/ml,诱导插管后以3μg·kg-1·h-1静脉泵注10min,再以0.3μg·kg-1·h-1恒速维持至手术结束。S组及P组则于诱导插管后按相同速度静脉泵注生理盐水至手术结束。术中调节各组七氟醚和丙泊酚用量,以维持BIS在45±5。术后记录患者停药至睁眼的时间,并用短期定向记忆实验测量患者的认知功能。结果术后苏醒期,S组、P组和SD组的睁眼时间组间无统计学差异,但PD组患者睁眼时间较其他3组显著延长(P〈0.05)。术前及术后60min,4组患者MMSE评分差异无统计学意义。结论右旋美托咪啶不会影响患者术后的认知功能恢复,但它会延长静脉麻醉患者的苏醒时间。  相似文献   

9.
目的:通过实时监测控制性降压肩关节镜手术患者术中脑氧饱和度(cerebral oxygen saturation, rSO 2)的变化,探讨七氟醚与丙泊酚对允许性高碳酸血症改善rSO 2作用的影响。 方法:选择择期行肩关节镜手术患者52例,ASA分级Ⅰ、Ⅱ级,年龄18~65岁,按随机数...  相似文献   

10.
目的探讨急性等容性血液稀释对控制性降压期间血清胱抑素(Cys-C)的影响。方法选择40例择期脊柱手术病人,随机分为4组,对照组、控制性降压组、血液稀释组和血液稀释联合控制性降压组,每组10例。用0.01%硝普钠进行控制性降压,将MAP维持在60~70mmHg;通过静脉采血和输液进行血液稀释,将Hct降至25%~30%;测定Cys-C含量。结果控制性降压组Cys-C含量明显升高(P〈0.05)。结论单纯控制性低血压可使肾小球滤过率(GFR)降低,而联用血液稀释则对肾功能有保护作用。  相似文献   

11.
目的比较单独用硝酸甘油与硝酸甘油加艾司洛尔,在颅脑手术时行控制性降压的效果。方法34例在异氟烷全麻下行颅脑手术病人,随机分为硝酸甘油组(Ⅰ组,16例)和硝酸甘油复合艾司洛尔组(Ⅱ组,18例),术中MAP降至并维持在60~65mmHg,观察此降压期间血流动力学的变化。结果1.两组各行控制性降压时间无显著差异。2.Ⅱ组硝酸甘油平均用量和总用量比Ⅰ组分别减少42%和39%(P<0.05)。3.Ⅰ组降压后心率明显增快(P<0.05)。Ⅱ组合并使用艾司洛尔50μg·kg-1·min-1后,心率变化不大,各时段心率均慢于Ⅰ组(P<0.01)。4.两组降压所需时间和停降压药后血压回升时间无显著差异(P>0.05)。结论异氟烷全麻下的颅脑手术患者,术中行控制性降压至MAP60~65mmHg,如联合应用硝酸甘油和艾司洛尔,可显著减少硝酸甘油的用药量,并可避免降压过程中的心率增快,使降压过程确切、满意。  相似文献   

12.
目的探讨七氟醚静吸复合麻醉控制性降压用于鼻内窥镜手术的安全性和可行性。方法选择择期鼻内窥镜手术患者40例,ASA Ⅰ或Ⅱ级,无凝血功能障碍,随机均分为控制性降压组(Ⅰ组)和非控制性降压组(Ⅱ组)。两组麻醉诱导均为咪唑安定、丙泊酚、维库溴铵、芬太尼;麻醉维持为七氟醚、芬太尼、丙泊酚、维库溴铵。术中Ⅰ组手术开始后逐渐增加七氟醚浓度至目标血压(MAP70mmHg),并维持在65~75mmHg。比较两组术中出血量?手术时间,术中监测心电图、有创MAP、HR和SpO2,记录时点为手术开始前即刻(T0)?手术20min(T1)、手术结束后10min(T2)。于手术结束后30min行血气分析。结果与T0时比较,Ⅰ组T1时MAP显著下降(P<0.01),T2时回升。T1时Ⅰ组MAP较Ⅱ组显著下降(P<0.01)。两组各时点HR差异无统计学意义。Ⅰ组比Ⅱ组手术出血量明显减少(P<0.01)。Ⅰ组比Ⅱ组手术时间明显缩短(P<0.01)。两组血气分析值均在正常范围,两组均未出现心律失常及心肌缺血征象。结论七氟醚静吸复合麻醉控制性降压用于鼻内窥镜手术能有效减少出血量,缩短手术时间,无明显并发症及不良反应。  相似文献   

13.
Morsellized bone-graft handling during spine surgery to get vertebral fusion can be a slow, laborious and time-consuming procedure. It is not absolutely exempt from complication risk. An easy, quick and inexpensive alternative technique is described.  相似文献   

14.
目的观察瑞芬太尼用于鼻内镜手术控制性降压对应激反应的影响。方法择期全麻下鼻内镜手术患者60例,ASAI-Ⅱ级,根据降压所用药物不同分为硝普钠组(N组,n=20)、瑞芬太尼组(R组,n=28)及瑞芬太尼复合硝普钠组(RN组,n=12)。常规麻醉诱导后,术者进行消毒时开始行控制性降压,维持MAP在60mmHg-70mmHg之间。分别记录控制性降压前即刻(L),维持降压30min时(T1)及停止降压待血压自然恢复稳定后(T2)的HR、MAP。于T0、T1、T2时分别抽取动脉血测定血管紧张素Ⅱ(AT-Ⅱ)、醛固酮(ALD)、血栓烷B2(TXB2)、6-酮-前列腺素F1α(6-keto-PGFlα)、内皮素(ET)和一氧化氮(NO)的浓度。结果三组患者相比T1时点,N组HR比R组和RN组明显增快(P〈0.05),N组降压停止后出现反跳性高血压,R组和RN组停止降压后MAP回复至降压前水平。T1、T2时点N组AT-Ⅱ、ALD的浓度比R和RN组明显升高(P〈0.05)。T1、T2时点RN组NO/ET比值明显高于同时点N组(P〈0.05),T2时点R组NO/ET比值明显高于同时点N组(P〈0.05)。T1、T2时点R、RN组TXB2/PGF1α比值明显高于同时点R和RN组(P〈0.05)。结论瑞芬太尼持续输注用于异氟醚吸入麻醉下鼻内镜手术中控制性降压能够降低AT-Ⅱ和ALD的分泌,改善NO/ET平衡,降低TXB2/PGF1α比值,有效抑制机体应激反应。  相似文献   

15.
Background contextInduced hypotension is widely used intraoperatively to reduce blood loss and to improve the surgical field during spinal surgery.PurposeTo determine the effect of milrinone on induced hypotension during spinal surgery in elderly patients.Study design/settingProspective randomized clinical trial.Patient sampleForty patients, 60 to 70 years old, ASA I–II, who underwent elective lumbar fusion surgery.Outcome measuresIntraoperative hemodynamics, blood loss, hourly urine output, and grade of surgical field.MethodsAll patients were randomized to group M or N. The study drug was infused after perivertebral muscle retraction until complete interbody fusion. In group M, 50 μg/kg/min of milrinone was infused over 10 minutes as a loading dose followed by 0.6 μg/kg/min of milrinone as a continuous dose. In group N, an identical volume of normal saline was infused in the same fashion. This study was not funded by commercial or other sponsorship and the authors confirm no conflicts of interest, financial or otherwise.ResultsDuring infusion of the study drug, the systolic and mean blood pressures were maintained within adequate limits of induced hypotension in group M. Intraoperative blood loss was 445.0±226.5 mL in group M and 765.0±339.2 mL in group N (p=.001). Hourly urine output was 1.4±0.6 mL in group M and 0.8±0.2 mL in group N (p<.001). The grade of the surgical field was better in group M than in group N (p=.004).ConclusionsWe conclude that milrinone is useful for induced hypotension in elderly patients during spinal surgery.  相似文献   

16.
The physical properties of sevoflurane suggest that it may be a suitable agent for controlled hypotension. With its low blood:gas partition coefficient of 0.69, it has a rapid onset of action making it easy to rapidly control blood pressure. The current report outlines preliminary experience with sevoflurane for controlled hypotension during posterior spinal fusion in five adolescents. The patients ranged in age from 12 to 16 years and in weight from 49 to to 72 kg. The duration of controlled hypotension varied from two to three h. The expired sevoflurane concentration required to maintain the mean arterial pressure (MAP) at 55 to 65 mmHg varied from 2 to 4%. With sevoflurane, there was an increase in heart rate from baseline of 74±7 beats·min?1 to a maximum of 83±13 beats·min?1 (P=0.038). One patient required three intravenous doses of esmolol (10 mg each) for a heart rate in excess of 100 beats·min?1. Estimated blood loss varied from 300 to 850 ml. No patient received homologous blood. No excessive hypotension was noted with sevoflurane. No patient required calcium, alpha adrenergic agonists, or ephedrine for excessive hypotension. When controlled hypotension was no longer necessary, the sevoflurane concentration was decreased to 1%. After decreasing the sevoflurane to 1%, the time to return of the MAP to baseline varied from 4 to 8 min (5.6±1.8 min).  相似文献   

17.
目的:观察脑深部电刺激术(deep brain stimulation, DBS)术中乌拉地尔不同给药方式对控制性降压效果的影响。方法:回顾性纳入行DBS的帕金森病(Parkinson disease, PD)患者179例,术中使用乌拉地尔进行控制性降压,分为乌拉地尔持续泵注组(C组,92例)和乌拉地尔分次静脉推注组(...  相似文献   

18.
脊柱手术中应用雷米芬太尼控制性降压的研究   总被引:3,自引:0,他引:3  
目的对比评价脊柱手术中应用雷米芬太尼或硝酸甘油行控制性降压麻醉的效果。方法30例后路椎间盘(植骨)融合术的病人,年龄18~65岁,随机分为雷米芬太尼组(R组)和硝酸甘油组(N组),每组15例。两组病人麻醉诱导及维持方法相同。R组以雷米芬太尼2μg/kg静注,0·1~0·5μg·kg-1·min-1维持;N组以硝酸甘油2μg/kg静注,0·5~3μg·kg-1·min-1维持,均将MAP降至60~65mmHg,持续60min。观察两组病人术中MAP、CVP、HR变化,失血量及清醒拔管时间的差异。结果降压期间R组的HR显著低于降压前(P<0·05,P<0·01),而N组显著高于降压前(P<0·05)。N组降压5、10、15min时的CVP显著低于降压前(P<0·05),R组与降压前相比差异无显著意义。R组术中失血量明显少于N组(P<0·01)。两组病人清醒拔管时间差异无显著意义。结论雷米芬太尼可有效用于脊柱手术术中控制性降压。与硝酸甘油相比,具有减慢HR、降压平稳、对CVP影响小、失血量少等优点。  相似文献   

19.
目的探讨右美托咪定联合硝普钠控制性降压在腔内隔绝术中应用的安全性和有效性。方法选择诊断为DebakeyⅢ型夹层动脉瘤拟行腔内隔绝术的患者40例,男32例,女8例,年龄27~79岁,ASAⅡ或Ⅲ级,随机分为硝普钠组(S组)和右美托咪定联合硝普钠组(SD组),每组20例。SD组全麻诱导前给予右美托咪定1μg/kg,15min内泵注完毕;S组给予等量的生理盐水,两组均在切皮时泵注硝普钠实施控制性降压。记录两组患者入手术室时(T0)、泵注硝普钠后5min(T1)、10min(T2)及停止泵注硝普钠后5 min(T3)、10 min(T4)的SBP、HR;记录达到目标血压(70~90mm Hg)所用的时间、硝普钠的平均用量及手术麻醉过程中不良反应的发生情况。结果与T0时比较,T1~T3时S组、T1~T4时SD组的SBP明显下降,T3时S组、T1~T4时SD组的HR明显减慢(P0.05)。T3、T4时SD组的SBP明显低于S组,T1~T4时的HR明显慢于S组(P0.05)。SD组达到目标血压所用的时间明显短于S组(P0.05),硝普钠的平均用量明显少于S组(P0.05);SD组心动过速和术后躁动的发生率明显低于S组(P0.05)。结论右美托咪定联合硝普钠用于腔内隔绝术中控制性降压更平稳快速、安全有效。  相似文献   

20.
目的研究急性高容量血液稀释(AHH)联合控制性降压(CH)对脊柱手术患者全身炎症反应的影响。方法择期脊柱手术患者60例,随机分为三组,每组20例。AHH组在麻醉诱导平稳后以30ml/min的速率输入6%羟乙基淀粉(130/0.4)15ml/kg,AHH+CH组在行AHH的同时采用硝酸甘油进行CH,MAP控制在60~70mm Hg。对照组常规输入复方乳酸钠15ml/kg补充禁食禁饮、生理需要量及第三间隙损失量。分别在AHH前(T1)、AHH后(T2)、手术开始后2h(T3)、术毕(T4)、术毕24h(T5)采集外周静脉血测定血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞介素-6(IL-6)浓度。记录手术时间、术中失血量和输血量。结果与T1时比较,三组T3~T5时CRP、IL-6浓度明显升高(P<0.05)。与对照组比较,AHH组和AHH+CH组在T2~T5时CRP、IL-6浓度明显降低(P<0.05);T4、T5时,AHH组和AHH+CH组PCT浓度均明显降低(P<0.05),AHH组和AHH+CH组术中失血量、输血量明显减少(P<0.05)。结论AHH或AHH联合CH不仅可减少脊柱手术患者术中失血量及输血量,而且可有效抑制围术期PCT、CRP、IL-6的表达,降低全身炎症反应。  相似文献   

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