瑞芬太尼、丙泊酚复合七氟烷控制性降压在颅颌面正颌手术中的应用

目的探讨瑞芬太尼、丙泊酚复合七氟烷控制性降压，在颅颌面正颌手术中的麻醉效果和安全性。方法选择择期术中需行控制性降压的颅颌面正颌手术患者210例，随机分为两组，分别应用瑞芬太尼（R组）和硝酸甘油（A组），联合丙泊酚、七氟烷进行控制性降压，每组105例。麻醉前（TO）、麻醉诱导后（T1）、降压开始5min（T2）、10min（T3）、20min（T4）和30min（T5），记录心率、动脉收缩压、动脉舒张压、动脉平均压。结果两组患者在T2、T3、T4的MBP均有明显下降，与基础值比较差异有统计学意义（P〈0．01）；R组T2、T3时间点的HR较A组明显减慢（P〈0．01）；R组停止降压后血压回升较缓慢，而A组停止降压后血压回升较快。结论瑞芬太尼、丙泊酚复合七氟烷能有效平稳地降低血压．是颅颌面正颌手术中安全、有效的降压方法。

Application of Controlled Hypotension by Combination of Remifentanil,Diprivan and Sevoflurane in Craniofacial Orthognathic Surgery

Objective To explore the effect and safety of controlled-hypotension by combination of remifentanil,diprivan and sevoflurane in craniofacial orthognathic surgery.Methods Two hundreds and ten patients undergoing controlled hypotension during craniofacial orthognathic surgery were enrolled.The patients were divided into two groups randomly according to the use of antihypertensive drugs: remifentanil group(group R,n=105) and nitroglycerin group(group A,n=105).The heart rate,systolic blood pressure,diastolic blood pressure and mean blood pressure before anaesthesia(T0),after induction of anaesthesia(T1),5 minutes(T2),10 minutes(T3),20 minutes(T4) and 30 minutes(T5) after controlled hypotension were observed.Results The MAP of patients in the two groups at T2,T3 and T4 were significantly decreased compared with the baseline(P<0.01);The HR in group R at T2 and T3 were significantly decreased compared with group A(P<0.01);The blood pressure of group R rose to the baseline more slowly compared with group A.Conclusion The combination of remifentanil,diprivan and sevoflurane could control hypotension effectively and steadily,and is a safe and effective method for controlled-hypotension in craniofacial orthognathic surgery.