尼卡地平与瑞芬太尼对老年鼻内镜手术患者控制性降压期间脑氧代谢的影响

目的探讨尼卡地平与瑞芬太尼在老年鼻内镜手术患者控制性降压应用时对脑氧代谢的影响。方法择期行老年鼻内镜手术患者46例，随机分为2组：尼卡地平组（N组）和瑞芬太尼组（R组），每组23例。麻醉诱导后,2组进行控制性降压，N组采用尼卡地平、R组采用瑞芬太尼，分别记录麻醉诱导后(T0)、降压前即刻（T1）、降压后 15 min(T2)、降压后30 min(T3)、复压后15 min(T4)5个时点的心率（heart rate, HR)、动脉血压（mean arterial pressure, MAP)及脉氧饱和度（pulse oxygen saturation, SpO2）；抽取各时点外周动脉血及颈静脉血进行血气分析,并计算动脉血氧含量(arterial oxygen content, CaO2)、颈静脉血氧饱和度(jugular venous oxygen saturation, SjvO2)、静脉血氧含量(jugular veinoxygen content, CjvO2)、脑氧摄取率(cerebral extraction rate of oxygen, CERO2)。结果与T1时刻比较，T2、T3时刻2组MAP、SjvO2、CaO2、CERO2均明显降低(P<0.05)，R组HR在T3时刻明显降低(P<0.05)、CjvO2增加(P<0.05)；组间比较，2组HR、MAP、SpO2差异无统计学意义(P>0.05)。与R组比较，T2、T3时刻N组CjvO2、SjvO2水平明显升高（P<0.05），而CERO2水平明显降低(P<0.05)。结论尼卡地平较瑞芬太尼用于控制性降压对心率影响更小，且脑氧代谢降低得更显著，对老年患者更加安全。

Comparison of the effects of controlled hypotension on cerebral oxygen metabolism with nicardipine or remifentanil during functional endoscopic sinus surgery in elders

ObjectiveTo investigate the effects of controlled hypotension on cerebral oxygen metabolism with nicardipine or remifentanil during functional endoscopic sinus surgery (FESS) in elders. MethodsForty six patients undergoing FESS were studied, who were randomly divided into two groups: nicardipine group (group N) and remifentanil group (group R). After general anesthesia, both groups started controlled hypotension with remifentanil or nicardipine. Heart rate (HR), mean arterial pressure (MAP) and pulse oxygen saturation (SpO2) were monitored at the five follo wing time points, time instant after general anesthesia (To), time instant before controlled hypotension (T1), 15 min (T2) and 30 min (T3) after controlled hypotension, and 15 min after conclusion of controlled hypotension (T4). Arterial blood gas analysis and internal jugular vein blood gas analysis were also measured at the five time points above, and arterial oxygen content (CaO2), jugular venous oxygen saturation (SjvO2), jugular veinoxygen content (CjvO2) and cerebral extraction rate of oxygen (CERO2) were calculated by the results of blood gas analysis. ResultsCompared to T1, both groups had lower MAP, SjvO2, CaO2 and CERO2(P<0.05) at T2 and T3, and group R had higher CjvO2(P<0.05) and lower HR (P<0.05) at T3. There were no significant difference in HR, MAP and SpO2 between two groups (P>0.05). At T2 and T3, group R had lower CjvO2, SjvO2(P<0.05) and higher CERO2(P<0.05) than group N. ConclusionControlled hypotension with both remifentanil and nicardipine can achieve the goal, but nicardipine provide a less HR diminution and lower CERO2, and better for the elder patients during FESS.