胃癌根治术患者应用瑞芬太尼控制性降压的效果

目的探讨胃癌根治术患者应用瑞芬太尼控制性降压的效果。方法择期胃癌根治术患者42例,ASAⅠ-Ⅱ级,年龄30-64岁,随机分为对照组(C组)、瑞芬太尼降压组(R组)和硝普钠降压组(N组),每组14例。麻醉诱导:静脉注射咪达唑仑0.1 mg/kg、芬太尼5μg/kg、维库溴铵0.08 mg/kg和异丙酚2 mg/kg。气管插管后行间歇正压机械通气,潮气量(8-10)m l/kg,呼吸频率12次/m in,吸呼比1∶1.5,维持呼末二氧化碳分压(30-35)mm Hg(1 kPa=7.5 mm Hg)。麻醉维持:静脉输注异丙酚(50-100)μg.kg-1.m in-1和瑞芬太尼0.1μg.kg-1.m in-1,持续吸入异氟醚,间断静脉注射维库溴铵0.04 mg/kg。切开腹膜时C组维持瑞芬太尼输注速率不变;R组瑞芬太尼输注速率每分钟增加0.05μg.kg-1.m in-1;N组静脉输注硝普钠起始速率1μg.kg-1.m in-1,每分钟增加0.5μg.kg-1.m in-1。R组和N组MAP降至麻醉前的70%但不低于50 mm Hg。记录控制性降压诱导时间和血压恢复时间、停药后清醒时间、拔管时间和出院时间;记录术中尿量、出血量、输血量;于麻醉诱导前(T0)、降压前即刻(T1)、降压达目标血压后10分钟(T2)、30分钟(T3)和停止降压后20分钟(T4)时,记录MAP、HR;记录术前和术后1、5天时的MMSE评分。结果R组控制性降压诱导时间及血压恢复时间显著长于N组,但R组血压明显较N组稳定。R组失血量明显少于N组及C组(p<0.01)。3组MMSE评分无差异。结论胃癌根治术患者使用瑞芬太尼降压可产生良好且平稳的控制性降压效果,减少出血量。

Effects of Remifentanil-induced to Control Hypotension on the Radical Operation of Gastric Cancer

Objective To investigate the effects of remifentanil-induced to control hypotension （CH） on the patients undergoing radical operation for gastric cancer. Methods Forty-two ASA Ⅰ - Ⅱ patients （26 male, 16 female） aged 30 -64 yr undergoing radical operation for gastric cancer were randomly divided into 3 groups （n = 14 each） ： group Ⅱ remifentanil-induced to control hypotension; group N sodium nitroprusside （SNP）-induced CH and group C normal BP. MAP, HR, ECG and SpO2 were continuously monitored. Anesthesia was induced with midazolam 0.1 mg/kg, fentanyl 5p.g/kg, propofol 2 mg/kg and vecuronium 0.08 mg/kg and maintained with inhaled isoflurane, iv infusion of propofol （50 -100 μg · kg^-1 · min^-1） and remifentanil （0.1 μg · kg^-1 · min^-1） and intermittent iv boluses of vecuronium. The patients were mechanically ventilated （ VT 8 - 10 ml/kg, RR 12 bpm, I： E 1 ： 1.5） after tracheal intubation. End-tidal CO2 was maintained at 30 - 35 mm Hg. CH started after abdomen was opened. In group R the remifentanil infusion rate was increased from 0. 1 μg · kg^-1 · min^-1 in 0.05 μg · kg^-1 · min^-1 increment every minute until the desired BP was achieved, while in group N SNP infusion rate was increased from 1 μg · kg^-1 · min^-1 in 0.5 μg · kg^-1 · min^-1 increment every minute until the desired BP was achieved. MAP was reduced to 70% of the baseline value but never below 50 mm Hg. CH induction time and BP recovery time were recorded. The volume of blood loss and blood infused and postoperative complication were also recorded. Results The CH induction time and BP recovery time were significantly longer in group R than that in group N but BP was more stable during CH in group R than that in group N. No complication was observed after operation in all 3 groups. Conclusion Remifentanil can effectively induce CH and reduce blood loss during operation.