摘要
目的观察全髋关节置换术中瑞芬太尼行控制性降压的效果及对肾素-血管紧张素系统的影响。方法择期行全髋关节置换术患者45例,ASAⅠ～Ⅱ级,随机分为3组,每组15例:瑞芬太尼控制性降压组(R组),硝普钠控制性降压组(N组)和瑞芬太尼常压对照组(C组)。通过调节瑞芬太尼及硝普钠的输注速度来进行控制性降压,R组瑞芬太尼输注速率从0.1～0.2μg·kg-1·min-1开始逐渐加大,每分钟增加0.05μg·kg-1·min-1;N组静脉输注硝普钠初始速率1μg·kg-1·min-1,每分钟增加0.5μg·kg-1·min-1,直到降低到平均动脉压基础值的70%但不低于55mmHg;C组不行控制性降压。记录麻醉诱导前(T0)、降压前即刻(T1)、降压达目标血压后10min(T2)、30min(T3)和停止降压后20min(T4)的MAP、HR、CVP及血浆中肾素(PRA)、血管紧张素Ⅱ(A-Ⅱ)、醛固酮(ALD)含量;评估术野质量、出血量。结果 R组和N组均能控制血压于目标水平;R组T2-4的HR较N组、C组同时点及本组T0、T1均显著减慢(P均<0.05);R组、C组各时点PRA、A-Ⅱ、ALD含量比较差异无统计学意义(P均>0.05),N组T2～4时点PRA、A-Ⅱ含量较R组、C组同时点及本组T0、T1均显著增高(P均<0.05);R组出血量、术野质量评分较N组、C组显著减少(P<0.05)。结论瑞芬太尼控制性降压在全髋关节置换术中可产生较好的效果,可控性佳,降压恢复平稳,改善了手术术野,明显减少出血量,降压过程RAAS未被过度激活。
Objective To investigate the efect of controlled hypotension with remifentanil and the diversity of renin-angiotensin-aldosterone system in total hip arthroplasty. Methods Forty-five patients undergoing elective total hip arthroplasty, with ASAI - II, were equally randomized into three groups,： Group R, remifentanil-induced hypotension. Group N, sodium nitroprusside-indueed hypotension. Group C, remifentanil-maintained normal arterial tension. Adjust remifentanil and sodium nitroprusside infusion rate for controlled hypotension, In group R the renifentanil infusion rate was increased from 0.1-0.2 ug · kg- 1 , min-1 in 0.05ug ·kg-1 ·min-1 increment every minute until the desired BP was achieved,while in group N sodium nitroprusside infusion rate was increased from 1 ug · kg-1 ·min-1 in 0.5 ug · 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 55mmHg. HR, MAP and CVP were measured, and plasma levels of rennin（PRA）, angiotensin（AT- H ）and aldosterone（ALD）were detected before induction of anesthesia（T0）, immediately before induction of controlled hypotension （ T1 ）, 10 min （ T2 ） and 30min （ T3 ） after hypotension, and 20 min after termination of controlled hypotension（T4）. Results It was able to control the blood pressure to the target level In group R and group N,HR were lower in group R than in group N and group C from T2 to T4（P〈0.05）, Plasma levels of PRA, A- II , ALD were significantly increased in group N, but didn＇t change markedly in group R and group C from T2 to T4（P〈0.05）. Blood loss from the surgical field was less in group R than in group N. Conclusion Remifentanil can effectively induce controlled bypotension in patients undergoing total hip arthroplasty, good controllability reduce the amount of bleeding, and provides an ideal operating condition, depress the activity of RAAS during controlled hypotension.
出处
《成都医学院学报》
CAS
2012年第4期601-604,共4页
Journal of Chengdu Medical College
基金
四川省卫生厅基金项目(NO:100101)
