瑞芬太尼输注在颅脑手术中稳定血流动力学的作用

目的：比较在异氟醚麻醉下不同剂量瑞芬太尼对神经外科手术血流动力学的影响,评定最佳瑞芬太尼输注速度。方法：45例开颅手术患者随机分成3组,诱导成功后立即输注瑞芬太尼：A组0.05μg/（kg.min）、B组0.15μg/（kg.min）和C组0.25μg/（kg.min）,术中维持0.8%异氟醚吸入浓度不变。记录各时段MAP和HR变化以及血流动力学控制的整体评价指标。结果：B组患者血流动力学的控制较A组和C组更平稳。B组追加和停输瑞芬太尼的病例百分数（20%和24%）介于A组（69%和8%）和C组（12%和85%）。结论：复合异氟醚麻醉的颅脑手术中,建议输注瑞芬太尼的最佳速度为0.15μg/（kg.min）,其使血流动力学更平稳。

Role of Remifentanil Infusion in Maintaining Hemodynamic Stability during Neurosurgery

Objective：An optimal speed of remifentanil infusion was to be determined by comparing the role of different dose of remifentanil in maintaining hemodynamic stability during neurosurgery under isoflurane anesthesia. Methods： Forty-five patients treated by intracranial surgery were randomly divided into three groups with 15 patients each： 0.05 μg/（kg · min） （Group A） ,0.15 μg/（kg ·min） （Group B） and 0.25 μg/（kg · min） （Group C） according to the in- fusion rate of remifentanil after successful induction. The stable concentration of isoflurane 0.8% was maintained during neurosurgery. Heart rate （HR） and mean arterial pressure （MAP） in different stimulus stages were recorded. The overall quality of the intraoperative hemodynamic control was evaluated by the attending anesthesiologist. Results：The stability of the hemodynamic control in Group B was better than that in Group A or Group C. The case percent of supplemental and discontinued boluses of remifentanil infusion in Group B （20% vs 24%） was between Group A （69% vs 8%） and Group C （12% vs 85%）. Conclusion：An optimal remifentanil infusion rate of 0. 15 μg/（kg · min）provid more stable hemodynamic conditions during neurosurgery under isoflurane anesthesia.