Yun So Hui, Kim Jeong Hong, Kim Hyun Jung
Department of Anesthesiology and Pain Medicine, Jeju National University School of Medicine, Aran 13gil 15, Jeju, Jeju Special Self-governing Province, 690-767, Republic of Korea.
J Anesth. 2015 Feb;29(1):35-9. doi: 10.1007/s00540-014-1856-0. Epub 2014 Jun 21.
Controlled hypotension (CH) is a well-established technique to decrease blood loss and improve surgical visibility. Although nitroprusside and remifentanil have been safely and effectively used for this purpose, the hemodynamic changes that occur during CH are unclear. This study compared the effects of nitroprusside and remifentanil on hemodynamics using a noninvasive cardiac output monitor (Cheetah NICOM(®); Cheetah Medical Inc., Maidenhead, Berkshire, UK) for endoscopic sinus surgery (ESS).
Twenty-eight adult patients scheduled for ESS were randomly assigned to the nitroprusside group (n = 14) or remifentanil group (n = 14). After anesthesia induction, hypotension was induced with continuous infusion of nitroprusside or remifentanil at a target mean arterial blood pressure (MAP) of 60-70 mmHg. Cardiac index (CI), stroke volume index (SVI) and total peripheral resistance index (TPRI) were measured at 10-min intervals.
The heart rate was higher and SVI was lower in the nitroprusside group than in the remifentanil group during CH. There were no significant differences in MAP, CI or TPRI between the two groups. Both nitroprusside and remifentanil reduced MAP and TPRI during CH compared with baseline values. However, there was no significant change in CI.
Both nitroprusside and remifentanil were effective to induce CH and maintain CI during CH.
控制性低血压（CH）是一种成熟的减少失血和提高手术视野清晰度的技术。尽管硝普钠和瑞芬太尼已安全有效地用于此目的，但CH期间发生的血流动力学变化尚不清楚。本研究使用无创心输出量监测仪（Cheetah NICOM(®)；Cheetah Medical Inc.，英国伯克郡梅登黑德）比较硝普钠和瑞芬太尼在内镜鼻窦手术（ESS）中对血流动力学的影响。
28例计划行ESS的成年患者随机分为硝普钠组（n = 14）或瑞芬太尼组（n = 14）。麻醉诱导后，通过持续输注硝普钠或瑞芬太尼将平均动脉压（MAP）降至60 - 70 mmHg以诱导低血压。每隔10分钟测量心指数（CI）、每搏量指数（SVI）和总外周阻力指数（TPRI）。
CH期间，硝普钠组的心率高于瑞芬太尼组，SVI低于瑞芬太尼组。两组之间的MAP、CI或TPRI无显著差异。与基线值相比，硝普钠和瑞芬太尼在CH期间均降低了MAP和TPRI。然而，CI无显著变化。
硝普钠和瑞芬太尼在诱导CH及CH期间维持CI方面均有效。
