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目的:探讨瑞芬太尼复合硝普钠控制性降压对先天性小耳畸形患儿全耳廓再造Ⅰ期手术的可行性和安全性。方法:择期行全耳廓再造Ⅰ期手术患儿30例,分为Ⅰ组(未降压组)和Ⅱ组(降压组)各15例。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-1﹒min-1,硝普钠1μg﹒kg-1﹒min-1开始,不超过3μg﹒kg-1﹒min-1,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(MAP)﹑脉搏氧饱和度(SpO2),术前﹑降压30分钟﹑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﹑术后伤口引流量。结果:Ⅱ组降压后MAP与术前,术后及Ⅰ组相比差异有显著性(P<0.05),Ⅰ组﹑Ⅱ组HR变化差异无显著性,Ⅱ组ECG均为窦性心律,Ⅱ组术中失血量明显少于Ⅰ组,差异有显著性(P<0.05),术后引流管引流血量与未降压组差异无显著性。降压30分钟,停止降压后血乳酸浓度改变差异无显著性(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Ⅰ期手术,有效减少术中出血。
Objective: To investigate the feasibility and safety of remifentanil combined with sodium nitroprusside controlled hypotension in the treatment of congenital malformations of children with auricle reconstruction. Methods: Thirty patients with stage Ⅰ operation undergoing elective auricular reconstruction were divided into two groups (group Ⅰ and group Ⅱ) (group B). In the static inhalation combined with general anesthesia, intravenous micro pump infusion remifentanil 0.15 ~ 0.25μg before the start of surgery. kg-1. min-1, sodium nitroprusside 1μg. kg-1. min-1, no more than 3μg. kg-1. min-1, so that the average arterial pressure dropped to 55 ~ 65mmHg, and maintain this level to the end of surgery pressure bandage process, tapering withdrawal. Intraoperative monitoring of ECG, heart rate (HR), invasive mean arterial pressure (MAP), pulse oxygen saturation (SpO2), preoperative and antihypertensive 30 minutes ﹑ blood gas analysis and blood lactate concentration (Lac ), Record the amount of fluid infusion, urine output, postoperative wound drainage. Results: The MAP in group Ⅱ was significantly lower than that in group Ⅰ and group Ⅰ (P <0.05), but there was no significant difference in HR between group Ⅰ and group Ⅱ. The ECG in group Ⅱ was sinus rhythm, The intraoperative blood loss in group Ⅱ was significantly less than that in group Ⅰ (P <0.05), and there was no significant difference between the drainage volume and the group of non-depressurization after operation. Blood pressure was reduced 30min, no significant difference was found in blood lactic acid concentration after blood pressure was stopped (P> 0.05). Conclusion: The controlled hypotensive effect of remifentanil combined with sodium nitroprusside can be safely used in stage Ⅰ operation of pediatric auricle reconstruction and effectively reduce intraoperative bleeding.