靶控输注瑞芬太尼复合硝酸甘油在鼻内窥镜术中的应用

目的研究靶控输注瑞芬太尼复合硝酸甘油用于鼻内窥镜手术中控制性降压的效果。方法50例择期行鼻内窥镜手术患者，随机分为2组：硝酸甘油降压组（N组，n=25），硝酸甘油复合瑞芬太尼组（RN组，n=25）。记录2组控制性降压过程中血压、心率、瑞芬太尼靶控浓度、硝酸甘油泵入浓度、降压起效时间及硝酸甘油总量。结果RN组中2例患者出现降压封顶现象，N组中4例患者出现血压下降超过40％，退出研究。2组降压期间平均动脉压均低于降压前（P〈0．05），RN组的降压起效时间、硝酸甘油总量及降压期间的心率值均低于N组（P〈0．05）。结论瑞芬太尼靶控浓度[（4．9±0．5）ng／mL]复合硝酸甘油[0．5μg／（kg·min）]用于鼻内窥镜手术中控制性降压是可行的。

The Application of Target-controlled Infusion of Remifentanil with Nitroglycerin during Endoscopic Sinus Surgery

Objective To investigate the effect of controlled hypotension induced by target-controlled infusion of remifentanil with nitroglycerin during endoscopic sinus surgery. Methods Fifty patients undergoing selective endoscopic sinus surgery,were randomly assigned into nitroglycerin group（group N,n=25） and remifentanil group（group RN,n=25）. The MAP and HR in two groups were recorded before anesthesia and controlled hypotension. The concentration of remifentanil and nitroglycerin, the sum of nitroglycerin,The time gaining hypotension were also recorded. Results The hypotensive ceiling-efect of remifentanil was produced in 2 patients of group RN. The MAP of 4 patients was lower than 40 % of the preoperative MAP and these patients were excluded. MAP in two groups during controlled hypotension were lower than those before hypotension （P〈0.05）. The time gaining hypotension,the sum of nitroglycerin, HR during controlled hypotension in group RN were lower than those in group N（P〈0.05）. Conclusion Induced hypotension by target-controlled infusion of remifentanil at （4, 9 ± 0.5）ng/mL with nitroglycerin at 0.5 μg/（kg · min） during endoscopic sinus surgery is feasible.