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目的探讨瑞芬太尼复合硝普钠控制性降压,做小儿全耳廓再造Ⅱ期手术的可行性和安全性。方法择期行全耳廓再造Ⅱ期手术患儿30例,分为Ⅰ组(未降压组n=15)和Ⅱ组(降压组n=15)。在静吸复合全身麻醉下,手术开始前静脉微泵输注瑞芬太尼0.15-0.25μg/(kg·min),硝普钠1μg/(kg·min)开始,不超过3μg/(kg·min),使平均动脉压降至55～65mmHg,并维持此水平至手术结束加压包扎过程中,逐渐减量停药。术中监测心电图(ECG)、心率(HR)、有创平均动脉压(MBP)、脉搏氧饱和度(SpO2),术前、降压30min、术毕分别做血气分析和血乳酸浓度(lac),记录输液量、出血量、尿量。结果Ⅱ组降压后MBP与术前,术后及Ⅰ组相比有统计学差异(P<0.05),Ⅰ组、Ⅱ组HR变化无差异,Ⅱ组ECG均为窦性心律,Ⅱ组术中失血量明显少于Ⅰ组,P<0.05有统计学差异。降压30min,停止降压后血乳酸浓度改变无统计学差异(P>0.05)。结论瑞芬太尼复合硝普钠控制性降压可安全用于小儿全耳廓再造Ⅱ期手术,有效减少术中出血。
Objective To investigate the feasibility and safety of remifentanil combined with sodium nitroprusside in the control of hypotension and to make pediatric auricle reconstruction stage Ⅱ. Methods Thirty patients with stage Ⅱ operation underwent elective auricular reconstruction were divided into group Ⅰ (n = 15) and group Ⅱ (n = 15). Venous micro-pump infusion of remifentanil 0.15-0.25μg / (kg · min), sodium nitroprusside 1μg / (kg · min), no more than 3μg / (kg · min), so that the average arterial pressure dropped to 55 ~ 65mmHg, and maintain this level to the end of surgery pressure bandaging process, tapering withdrawal. Intraoperative monitoring of ECG, heart rate (HR), mean arterial pressure (MBP), pulse oxygen saturation (SpO2), preoperative and antihypertensive 30min, blood gas analysis and blood lactic acid concentration (lac) , Record infusion, bleeding, urine output. Results Compared with preoperative, postoperative and group Ⅰ, MBP in group Ⅱ was significantly lower than that in group Ⅰ and group Ⅱ (P <0.05), there was no difference in HR between group Ⅰ and Ⅱ, group Ⅱ was sinus rhythm, group Ⅱ The blood loss was significantly less than in group Ⅰ, P <0.05 had statistical difference. After 30min depressurization, there was no significant difference in blood lactic acid concentration after stopping decompression (P> 0.05). Conclusion Remifentanil combined with sodium nitroprusside controlled hypotension can be safely used in pediatric auricle reconstruction stage Ⅱ surgery, effectively reducing intraoperative bleeding.