| OBJECTIVE:To investigate the effect of remifentanil- sevoflurane induced controlled hypotension on renin-angiotensin-aldosterone system of patients undergoing endoscopic sinus surgery,compared with that induced by sodium nitroprusside(SNP) and sevoflurane.METHODS:eighty ASAⅠ～Ⅱpatients undergoing selective endoscopic sinus surgery were randomly divided into four groups,each group(n=20):two groups patients received remifentanil(R1and R2),two groups patients received sodium nitroprusside(N1and N2).In group R1 and N1,mean arterial blood pressure(MAP)was maintained within the target range of 60 to 65 mmHg.In group R2 and N2,mean arterial blood pressure(MAP)was maintained within the target range of 66 to 70 mmHg.The scores of surgical field quality(SSFQ)were assessed by the same surgeon who blinded to the hypotensive agent used at 5(T+5),15(T+15),25(T+25),35(T+35),45 (T+45) minute according to Fromme scores of surgical field quality list.Blood samples were taken from artery and detected for blood gas analysis,blood lactate,plasma levels of renin(PRA),angiotensin(AT-Ⅱ)and aldosterone(ALD)at base (T0),before controlled hypotension(To) and at 25 min of beginning operation(T25) and at the end of operation(Tend).The duration of operation and hypotension,the time from the end of the operation to extubation of the tracheas,the time from before hypotension to target MAP reduced were determinded. RESULTS:HR got quicker in group N1and N2(P＜0.05),and slower in group R1 and R2,the time from the end of the operation to extubation of the tracheas is longer in group N1and N2.There were no significant differences in the MAP during controlled hypotension between group R1 and group N1(P＞0.05),but the SSFQ in group R1 was significantly lower than those in group N1(P＜0.01).There were no significant differences in the MAP during controlled hypotension between group R2 and group N2(P＞0.05),the SSFQ in group R2 was significantly lower than those in group N2,(P＜0.01).Compared with group R1,the SSFQ in group R2 was slightly impaired but not critically(P＞0.05).Compared with To,there was no significant differences in blood gas and lactate in every group(P＞0.05).Plasma levels of PRA,AT-Ⅱand ALD were significantly increased in group N1and N2 but didn't change markedly in group R1and R2 compared with that at To.CONCLUSION:Compared with sodium nitroprusside,remifentanil combined with sevoflurane enabled controlled hypotension and provided better surgical condition for endoscopic sinus surgery within the target range of MAP 66 to 70 mmHg,maintains RAAS at a stale status.
|
PDF Full Text Request