瑞芬太尼靶控静脉麻醉复合异氟醚在鼓室成形术中的应用

目的：评价异氟醚复合瑞芬太尼靶控静脉麻醉在鼓室成形术中行控制性降压的应用。方法 ASAⅠ-Ⅱ级需择期行鼓室成形术患者30例，年龄30-50岁，随机分为异氟醚复合瑞芬太尼组（R 组）和异氟醚复合硝普钠组（X 组），连续监测平均动脉压、心率、脉搏血氧饱和度、呼气末二氧化碳分压和心电图，分别记录麻醉诱导前、降压后10 min、降压后30 min 及停止降压后10 min 时的血流动力学变化，计算心率、收缩压乘积，同时记录降压起效时间（开始降压到达到目标血压所需时间）、降压时间、手术时间、术毕拔管时间。结果 R 组与 X 组比较起效时间较慢，但术野质量、术毕拔管时间以及血流动力学稳定性都优于 X 组。结论与常规控制性降压相比，瑞芬太尼靶控静脉麻醉其诱导更平稳，降压效果更优，但由于其代谢更快，术后镇痛应较早开始。

Isoflurane combined with remifentanil arget controlled intravenous anesthesia in tympanoplasty

Objective To evaluate the effect of isoflurane combined with remifentanil target-con-trolled intravenous anesthesia on tympanoplasty. Methods ASA Ⅰ - Ⅱ stage need tympanoplasty in 30 cases,aged 30 - 50 years old,were randomly divided into isoflurane combined with remifentanil group （group R）,sodium nitroprusside group（group X）,and the levels of MAP,HR,SpO2 ,PET CO2 and ECG were continuously monitored,respectively. Before induction of anesthesia（T1）,10 min after hypoten-sion（T2）,30 min after hypotension（T3）and stop 10 min after hypotension（T4）,the hemodynamic changes of heart rate,systolic blood pressure and calculation of product（RPP）were recorded,buck on-set time（starting antihypertensive to achieve target blood pressure time required）,blood pressure reduc-ing time,the operation time,postoperative extubation time were recorded. Results Compared with group X,the onset time in group R was later,but the surgical field quality,postoperative extubation time and hemodynamic changes were better. Conclusions Compared with conventional controlled hypoten-sion,target-controlled intravenous remifentanil anesthesia induces more smoothly,the antihypertensive effect is better, but because of its faster metabolism,postoperative analgesia should be an earlier start.