不同全麻方法复合硝普钠控制性降压对机体肾功能的影响
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摘要
目的
观察三种不同全麻方法复合硝普钠控制性降压时患者血流动力学的变化差异;研究三种不同全麻方法复合硝普钠控制性降压对机体肾功能的影响。
方法
选择择期口腔颌面部整形患者30例,ASAⅠ～Ⅱ级,随机分为三组:芬太尼复合异氟烷吸入麻醉组(Ⅰ组)、芬太尼和丙泊酚复合异氟烷吸入麻醉组(Ⅱ组)、瑞芬太尼复合丙泊酚全凭静脉麻醉组(Ⅲ组),每组各10例患者。三组均用硝普钠行控制性降压,将平均动脉压(mean arterial pressure,MAP)降低30%左右,维持40分钟以上。分别记录麻醉前(T_0)、麻醉后降压前(基础值,T_1)、降压后10分(T_2)、20分(T_3)、40分(T_4)、停止降压后2分(T_5)、5分(T_6)、10分(T_7)、15分(T_8)、20分(T_9)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、MAP、心率(heart rate,HR)、率压积(rate pressure product,RPP,即SBP×HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO_2)、呼气末二氧化碳分压(end-tidal carbondioxide partial pressure,P_(ET)CO_2)。于T_1、T_4及T_7三个时间点,分别抽取病人动脉血标本5ml,采用放射免疫法检测血β_2-微球蛋白(β_2-MG)的水平。
结果
1、MAP:在停止降压后的T_5、T_7时,Ⅲ组明显低于Ⅰ组(P＜0.05);T_6时,Ⅲ组明显低于Ⅰ组、Ⅱ组(P＜0.05);与T_1相比,Ⅰ组患者的MAP在T_5、T_6、T_7、T_8时,均显著升高(P＜0.05);Ⅱ组患者的MAP从T_6时开始升高,在T_7、T_8时均高于基础水平(P＜0.05)。
2、HR:控制性降压开始后T_2、T_3、T_4时,与T_1相比,三组的HR均升高(P＜0.05);但Ⅲ组明显低于Ⅰ组、Ⅱ组(P＜0.05)。
3、RPP:在控制性降压开始后T_2、T_3、T_4时,直至停止降压后T_5、T_6、T_7时,与T_1相比,Ⅰ组、Ⅱ组患者的RPP均明显高于基础水平(P＜0.05)。在控制性降压过程中,即T_2、T_3、T_4时,Ⅲ组患者的RPP明显低于Ⅰ组、Ⅱ组(P＜0.05);在停止降压后T_5、T_6、T_7时,Ⅲ组患者的RPP仍明显低于Ⅰ组(P＜0.05)。
4、β_2-MG:与T_1相比,在T_4时三组患者的β_2-MG均有所升高,而在T_7时各组的β_2-MG均有所下降是但是各组的具体数值的变化没有显著性差异,为排除患者控制性降压之前血液内基础水平彼此各不相同的干扰以及保证科研统计数据时的同质化原则,将每个病人T_1、T_4、T_7彼此间的差值计算得出后再与其各自的T_1相比得出的比值记为变化率;即得到相应两时间点间的变化率(Rate ofChange,RC):RC01=(T_4-T_1)/T_1;以及相应两时间点间的变化率:RCO2=(T_1-T_7)/T_1分别表示排除患者自身控制性降压前的血液内基础水平彼此各不相同的干扰单纯比较各种麻醉方法的不同导致其控制性降压前后血液β_2-MG变化程度的大小。与T_1相比,在T_4时Ⅲ组患者的RC01均明显低于于Ⅰ组、Ⅱ组(P＜0.05);在T_7时,Ⅲ组患者RCO2明显低于Ⅰ组、Ⅱ组(P＜0.05)。
结论
全凭静脉麻醉下,即用丙泊酚-瑞芬太尼麻醉维持,使用硝普钠进行控制性降压能提供稳定的血流动力学状态;其控制性降压前后β_2-MG升高和降低的变化程度都比较缓和,从而减少控制性降压对围手术期机体的肾功能的影响,降低控制性降压对机体肾脏功能的干扰,提高患者肾脏对手术和应激刺激的耐受能力,降低术后肾脏可能发生肾功能损伤并发症风险的可能性,从而促进术后恢复。
Objective
To study the effect of hemodynamics and the renal function made by combination of three different methods of general anesthesia with controlled hypotension with Sodium Nitroprusside(SNP).
Methods
Thirty patients,ASAⅠ～Ⅱ,scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups.All of them were under the condition of controlled hypotension induced by SNP.GroupⅠ:isoflurane-fentanyl group(n =10); groupⅡ:isoflurane-propofol-fentanyl group(n =10);groupⅢ:propofol-remifentanil group(n =10).The objectives of anesthesia were to reduce MAP by 30%and to maintain more than 40 minutes.Before anesthesia(T_0);before controlled hypotension (basic values,T_1);10 minutes(T_2),20 minutes(T_3),40 minutes(T_4)after controlled hypotension;2 minutes(T_5),5 minutes(T_6),10 minutes(T_7),15 minutes(T_8),20 minutes(T_9)after stopping controlled hypotension,to record the date of these parameters:systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR),RPP(SBP×HR)value,pulse oxygen saturation(SpO_2),end-tidal carbon dioxide partial pressure(P_(ET)CO_2),rebound hypertension.Collected the arterial blood samples to assay the levels ofβ_2-MG by radioimmunoassay at T_1,T_4,T_7.
Results
1.MAP:In groupⅢ,MAP was significantly lower than groupⅠ(P＜0.05)at T_5,T_7. In groupⅢ,MAP was significantly lower than that in groupⅠand groupⅡ(P＜0.05)at T6.In group,MAP were significantly increased(P＜0.05)than groupⅡat the T_5,T_6,T_7, T_8.In groupⅡ,MAP began to increase at T_6,and still higher than basic level(P＜0.05) at T_7,T_8.
2.HR:At T2,T3,T4,HR increased(P＜0.05)in all three groups compared with T_1. But HR of groupⅢwas significantly lower than that of groupⅠand groupⅡ(P＜0.05).
3.RPP:In groupⅠandⅡ,RPP were significantly higher than the basic level (P＜0.05)at T_2,T_3,T_4,T_5,T_6,T_7.In groupⅢ,RPP was significantly lower than that of groupⅠandⅡ(P＜0.05)at T_2,T_3,T_4.In groupⅢ,RPP was still significantly lower than that of groupⅠ(P＜0.05)at T_5,T_6,T_7.
4.β_2-MG:At T_4,the level ofβ_2-MG was significantly higher than the basic level (P＜0.05)at T_1 and at T_7 the level ofβ_2-MG was still significantly lower than the basic level at T_1 in all the three groups(P＜0.05).There were no significantly differences of theβ_2-MG levels in each group at T_1,T_4,T_7.But in groupⅢ,the rate of change inβ_2-MG level was significantly lower than that of groupⅠ(P＜0.01)and groupⅡ(P＜0.05) at T_4;the rate of change inβ_2-MG level was significantly higher than that of groupⅠ(P＜0.01)and groupⅡ(P＜0.05)at T_7 In groupⅡ,the rate of change inβ_2-MG level was significantly lower than that of groupⅠ(P＜0.05)at T_4 and higher than that of groupⅠ(P＜0.05)at T_7 significantly.
Conclusion
Total intravenous anesthesia,which maintained by propofol and remifentanil and controlled hypotension induced by Sodium Nitroprusside,can provide the stable status of hemodynamics and reduce the influence on the renal function raise the tolerance of kidney on the stress of stimulations under the conditions of controlled hypotension in surgical operations.
观察三种不同全麻方法复合硝普钠控制性降压时患者血流动力学的变化差异;研究三种不同全麻方法复合硝普钠控制性降压对机体肾功能的影响。
方法
选择择期口腔颌面部整形患者30例,ASAⅠ～Ⅱ级,随机分为三组:芬太尼复合异氟烷吸入麻醉组(Ⅰ组)、芬太尼和丙泊酚复合异氟烷吸入麻醉组(Ⅱ组)、瑞芬太尼复合丙泊酚全凭静脉麻醉组(Ⅲ组),每组各10例患者。三组均用硝普钠行控制性降压,将平均动脉压(mean arterial pressure,MAP)降低30%左右,维持40分钟以上。分别记录麻醉前(T_0)、麻醉后降压前(基础值,T_1)、降压后10分(T_2)、20分(T_3)、40分(T_4)、停止降压后2分(T_5)、5分(T_6)、10分(T_7)、15分(T_8)、20分(T_9)的收缩压(systolic blood pressure,SBP)、舒张压(diastolic blood pressure,DBP)、MAP、心率(heart rate,HR)、率压积(rate pressure product,RPP,即SBP×HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO_2)、呼气末二氧化碳分压(end-tidal carbondioxide partial pressure,P_(ET)CO_2)。于T_1、T_4及T_7三个时间点,分别抽取病人动脉血标本5ml,采用放射免疫法检测血β_2-微球蛋白(β_2-MG)的水平。
结果
1、MAP:在停止降压后的T_5、T_7时,Ⅲ组明显低于Ⅰ组(P＜0.05);T_6时,Ⅲ组明显低于Ⅰ组、Ⅱ组(P＜0.05);与T_1相比,Ⅰ组患者的MAP在T_5、T_6、T_7、T_8时,均显著升高(P＜0.05);Ⅱ组患者的MAP从T_6时开始升高,在T_7、T_8时均高于基础水平(P＜0.05)。
2、HR:控制性降压开始后T_2、T_3、T_4时,与T_1相比,三组的HR均升高(P＜0.05);但Ⅲ组明显低于Ⅰ组、Ⅱ组(P＜0.05)。
3、RPP:在控制性降压开始后T_2、T_3、T_4时,直至停止降压后T_5、T_6、T_7时,与T_1相比,Ⅰ组、Ⅱ组患者的RPP均明显高于基础水平(P＜0.05)。在控制性降压过程中,即T_2、T_3、T_4时,Ⅲ组患者的RPP明显低于Ⅰ组、Ⅱ组(P＜0.05);在停止降压后T_5、T_6、T_7时,Ⅲ组患者的RPP仍明显低于Ⅰ组(P＜0.05)。
4、β_2-MG:与T_1相比,在T_4时三组患者的β_2-MG均有所升高,而在T_7时各组的β_2-MG均有所下降是但是各组的具体数值的变化没有显著性差异,为排除患者控制性降压之前血液内基础水平彼此各不相同的干扰以及保证科研统计数据时的同质化原则,将每个病人T_1、T_4、T_7彼此间的差值计算得出后再与其各自的T_1相比得出的比值记为变化率;即得到相应两时间点间的变化率(Rate ofChange,RC):RC01=(T_4-T_1)/T_1;以及相应两时间点间的变化率:RCO2=(T_1-T_7)/T_1分别表示排除患者自身控制性降压前的血液内基础水平彼此各不相同的干扰单纯比较各种麻醉方法的不同导致其控制性降压前后血液β_2-MG变化程度的大小。与T_1相比,在T_4时Ⅲ组患者的RC01均明显低于于Ⅰ组、Ⅱ组(P＜0.05);在T_7时,Ⅲ组患者RCO2明显低于Ⅰ组、Ⅱ组(P＜0.05)。
结论
全凭静脉麻醉下,即用丙泊酚-瑞芬太尼麻醉维持,使用硝普钠进行控制性降压能提供稳定的血流动力学状态;其控制性降压前后β_2-MG升高和降低的变化程度都比较缓和,从而减少控制性降压对围手术期机体的肾功能的影响,降低控制性降压对机体肾脏功能的干扰,提高患者肾脏对手术和应激刺激的耐受能力,降低术后肾脏可能发生肾功能损伤并发症风险的可能性,从而促进术后恢复。
Objective
To study the effect of hemodynamics and the renal function made by combination of three different methods of general anesthesia with controlled hypotension with Sodium Nitroprusside(SNP).
Methods
Thirty patients,ASAⅠ～Ⅱ,scheduled for oral and maxillofacial plastic surgery, were randomly divided into three groups.All of them were under the condition of controlled hypotension induced by SNP.GroupⅠ:isoflurane-fentanyl group(n =10); groupⅡ:isoflurane-propofol-fentanyl group(n =10);groupⅢ:propofol-remifentanil group(n =10).The objectives of anesthesia were to reduce MAP by 30%and to maintain more than 40 minutes.Before anesthesia(T_0);before controlled hypotension (basic values,T_1);10 minutes(T_2),20 minutes(T_3),40 minutes(T_4)after controlled hypotension;2 minutes(T_5),5 minutes(T_6),10 minutes(T_7),15 minutes(T_8),20 minutes(T_9)after stopping controlled hypotension,to record the date of these parameters:systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP)and heart rate(HR),RPP(SBP×HR)value,pulse oxygen saturation(SpO_2),end-tidal carbon dioxide partial pressure(P_(ET)CO_2),rebound hypertension.Collected the arterial blood samples to assay the levels ofβ_2-MG by radioimmunoassay at T_1,T_4,T_7.
Results
1.MAP:In groupⅢ,MAP was significantly lower than groupⅠ(P＜0.05)at T_5,T_7. In groupⅢ,MAP was significantly lower than that in groupⅠand groupⅡ(P＜0.05)at T6.In group,MAP were significantly increased(P＜0.05)than groupⅡat the T_5,T_6,T_7, T_8.In groupⅡ,MAP began to increase at T_6,and still higher than basic level(P＜0.05) at T_7,T_8.
2.HR:At T2,T3,T4,HR increased(P＜0.05)in all three groups compared with T_1. But HR of groupⅢwas significantly lower than that of groupⅠand groupⅡ(P＜0.05).
3.RPP:In groupⅠandⅡ,RPP were significantly higher than the basic level (P＜0.05)at T_2,T_3,T_4,T_5,T_6,T_7.In groupⅢ,RPP was significantly lower than that of groupⅠandⅡ(P＜0.05)at T_2,T_3,T_4.In groupⅢ,RPP was still significantly lower than that of groupⅠ(P＜0.05)at T_5,T_6,T_7.
4.β_2-MG:At T_4,the level ofβ_2-MG was significantly higher than the basic level (P＜0.05)at T_1 and at T_7 the level ofβ_2-MG was still significantly lower than the basic level at T_1 in all the three groups(P＜0.05).There were no significantly differences of theβ_2-MG levels in each group at T_1,T_4,T_7.But in groupⅢ,the rate of change inβ_2-MG level was significantly lower than that of groupⅠ(P＜0.01)and groupⅡ(P＜0.05) at T_4;the rate of change inβ_2-MG level was significantly higher than that of groupⅠ(P＜0.01)and groupⅡ(P＜0.05)at T_7 In groupⅡ,the rate of change inβ_2-MG level was significantly lower than that of groupⅠ(P＜0.05)at T_4 and higher than that of groupⅠ(P＜0.05)at T_7 significantly.
Conclusion
Total intravenous anesthesia,which maintained by propofol and remifentanil and controlled hypotension induced by Sodium Nitroprusside,can provide the stable status of hemodynamics and reduce the influence on the renal function raise the tolerance of kidney on the stress of stimulations under the conditions of controlled hypotension in surgical operations.
引文
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17 Valtonen M,Kuttila K,Kanto J,et al.Hypotensive anesthesia for middle ear surgery:a comparison of propofol infusion and isoflurane.Methods Find Exp Clin Pharmacol.1992; 14(5): 383-388.
18 Mulier JP, Wouters PF, Van Aken H, et al. Cardiodynamic effects of propofol in comparison with thiopental: assessment with a transesophageal echocardiographic approach. Anesth Analg. 1991; 72(1): 28-35.
19 Tomiyasu S, Hara T, Hasuo H, et al. Comparative analysis of systemic and coronary hemodynamics during sevoflurane-and isoflurane-induced hypotension in dogs. J Cardiovasc Pharmacol. 1999; 33(5): 741-747.
20 Bernard JM, Pinaud M, Francois T, et al. Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty. Anesth Analg. 1991; 73(3): 341-345.
21 Sharrock NE. Bading B, Mineo R, et al. Deliberate hypotensive epidural anesthesia for patients with normal and low cardiac output. Anesth Analg. 1994; 79(5): 899-904.
22 Drummond JC. The lower limit of autoregulation: time to revise our thinking? . Anesthesiology. 1997; 86(6): 1431-1433.
23 Hur SR, Huizenga BA, Major M, et al. Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine. 1992; 17(8): 867-873.
24 Endoh H, Honda T, Ohashi S, et al. The influence of nitroglycerin and prostaglandin EI on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia. Anaesthesia. 2001; 56(10): 947-952.
25 Milde LN, Milde JH. The cerebral and systemic hemodynamic and metabolic effects of desflurane-induced hypotension in dogs. Anesthesiology. 1991; 74(3): 513-518.
26 Khambatta HJ, Stone JG, Matteo RS. Effect of sodium nitroprusside-induced hypotension on pulmonary deadspace. Br J Anaesth. 1982; 54(11): 1197-1200.
27 Yamakage M, Iwasaki H, Satoh K, et al. Effects of induced hypotension on arterial blood-gases under spontaneous breathing. Acta Anaesthesiol Scand. 1994; 38(4): 368-371.
28 Toivonen J, Kaukinen S, Oikkonen M, et al. Effects of deliberate hypotension induced by labetalol on renal function. Eur J Anaesthesiol. 1991; 8(1): 13-20.
29 Nagata N, Matsukado T, Takeshita M, et al. Effect of deliberate hypotension on renal functions during epidural block plus inhalation anesthesia: a comparison of prostaglandin E1 and trimethaphan. Masui. 1994; 43(10): 1472-1477.
30 Piper SN, Haisch G, Kumle B, et al. Effects of esmolol-and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2003; 38(12): 781-786.
31 Jordan D, Shulman SM, Miller ED Jr. Esmolol hydrochloride, sodiumnitxoprusside.and isoflurane differ in their ability to alter peripheralsympathetic responses . Anesth Analg. 1993; 77(2): 281-290.
32 Andel D,Andel H,Horauf K,et al.The influence of deliberate hypotension on splanchnic perfusion balance with use of either isoflurane or esmolol and nitroglycerin.Anesth Analg.2001 Nov;93(5):1116-20.
33 Kick O,Van Aken H,Wouters PF,er al.Vital organ blood flow during deliberate hypotension in dogs.Anesth Analg.1993;77(4):737-742.
34 王心田,佘守章,谢富生等.异丙酚、异氟醚复合控制性降压用于颅脑手术的观察.中华麻醉学杂志.1999;19(6):346-347.
35 李树人,韩如泉,槐庆元等.七氟醚对犬血流动力学影响的实验研究.中华麻醉学杂志.1996;16(11):543.
36 Nakamura K,Toda H,Hatano Y,et al.Comparison of the direct effects of sevoflurane,isoflurane and halothane on isolated canine coronary arteries.Can J Anaesth.1993;40(3):257-261.
37 秋维,蔡惠敏,梁裕等.异丙酚与安氟醚在脊柱侧凸畸形后路矫正术麻醉中的比较.中华麻醉学杂志.1999;19(11):660-663.
38 Mikhail MS,Thangathurai D,Thaker KB,et al.Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin.J Cardiothorac Vasc Anesth.2000;14(5):565-570.
39 文亮,毕敏.硝普钠控制性降压及其并发症.中华麻醉学杂志.1991;11(1):33-34.
40 Ali SS,Dubikaitis A,al Qattan AR.The relationship between end tidal carbon dioxide and arterial carbon dioxide during controlled hypotensive anaesthesia.Med Princ Pract.2002;11(1):35-37.
41 Suttner SW,Lang K,Boldt J,et al.The influence of hyperoxic ventilation during sodium nitroprusside-induced hypotension on skeletal muscle tissue oxygen tension.Anesthesiology.2002;96(5):1103-1108.
42 Massoud TF,Hademenos G J,Young WL,et al.Can induction of systemic hypotension help prevent nidus rupture complicating arteriovenous malformation embolization?:analysis of underlying mechanism achieved using a theoretical model.AJNR Am J Neuroradiol.2000;21(7):1255-1267.
43 Degoute CS,Ray MJ,Manchon M,et al.Remifentanil and controlled hypotension;comparison with nitroprusside or esmolol during tympanoplasty.Can J Anaesth.2001;48(1):20-27.
44 Mikhail MS,Thangathurai D,Thaker KB,et al.Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin.J Cardiothorac Vasc Anesth.2000;14(5):565-570.
45 Pakulski C,Nowicki R,Kowalczyk P.et al.The influence of controlled hypotension on splanchnic mucosal perfusion using gastric tonometry in patients undergoing resection of meningioma.Med Sci Monit.2002;8(1):CR28-30.
46 李虹,张秀芝,张亚军等.硝普钠和硝酸甘油联合用于控制性降压的实验观察.中华麻醉学杂志,1999;19(9):526.
47 Hersey SL,O'Dell NE,Lowe S,et al.Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescents.Anesth Analg.1997;84(6):1239-1244.
48 Takeda S,Ozawa Y,Tomaru T.Haemodynamic effects of hypotension induced by KRN2391and nicardipine in isoflurane anaesthetized dogs.Can J Anaesth.1997;44(9):1002-1007.
49 Schoffstall JM,Spivey WH,Gambone LM,et al.Effects of calcium channel blocker overdose-induced toxicity in the conscious dog.Ann Emerg Med.1991;20(10):1104-1108.
50 Quartaroli M,Gambini F,Tarter G,et al.The hemodynamic effects of lacidipine in anesthetized dogs:comparison with nitrendipine,amlodipine,verapamil,and diltiazem.J Cardiovasc Pharmacol.1991;18(3):326-336.
51 Tobias JD,Berkenbosch JW.Initial experience with dexmedetomidine in paediatric-aged patients.Paediatr Anaesth.2002;12(2):171-175.
52 Noma T,Ichinohe T,Kaneko Y.Inhibition of physiologic stress responses by regional nerve block during orthognathic surgery under hypotensive anesthesia.Oral Surgy Oral Surg Oral Med Oral Pathol Oral Radiol Endod.1998;86(5):511-515.
53 Kikuta Y,Ohiwa E,Okada K,et al.Clinical application of diadenosine tetraphosphate (Ap4A:F-1500)for controlled hypotension.Acta Anaesthesiol Scand.1999;43(1):82-86.
54 Sato J,Saito S,Takahashi T,et al.Sevoflurane and nitrous oxide anaesthesia suppresses heart rate variabilities during deliberate hypotension.Eur J Anaesthesiol.2001;18(12):805-810.
55 Endoh H,Honda T,Ohashi S,et al.The influence of nicardipine-,nitroglycerin-,and prostaglandin E(1)-induced hypotension on cerebral pressure autoregulation in adult patients during propofol-fentanyl anesthesia.Anesth Analg.2002;94(1):169-173.
56 张诗海,曾帮雄,金士翱等.降钙素基因相关肤控制性降压对大鼠肝血流及氧供氧耗的影响.中华麻醉学杂志.1998;18(6):350-352.
57 张诗海,曾帮雄,金士翱等.降钙素基因相关肤控制性降压对大鼠血流动力学和器官血流的影响.中华麻醉学杂志.1997;17(2):94-96.
58 Guy J,Hindman BJ,Baker KZ,et al.Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions.Anesthesiology.1997;86(3):514-524.
59 Schuttler J,Albrecht S,Breivik H,et al.A comparison ofremifentanil and alfentanil in patients undergoing major abdominal surgery.Anaesthesia.1997;52(4):307-317.
60 Baker KZ,Ostapkovich N,Sisti MB,et al.Intact cerebral blood flow reactivity during remifentanil/nitrous oxide anesthesia.J Neurosurg Anesthesiol.1997;9(2):134-140.
61 Hogue CW Jr,Bowdle TA,O'Leary C,et al.A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery.Anesth Analg.1996;83(2):279-285.
62 Degoute CS,Ray M J,Gueugniaud PY,et al.Remifentanil induces consistent and sustained controlled hypotension in children during middle ear surgery.Can J Anaesth.2003;50(3):270-276.
63 Kazmaier S,Hanekop GG,Buhre W,et al.Myocardial consequences ofremifentanil in patients with coronary artery disease.Br J Anaesth.2000;84(5):578-583.
64 Sebel PS,Hoke JF,Westmoreland C,et al.Histamine concentrations and hemodynamic responses after remifentanil.Anesth Analg.1995;80(5):990-993.
65 江学成,张育才,胡宁利等.瑞芬太尼和异丙酚联合闭环靶控输注麻醉的可行性.中华麻醉学杂志.2004;24(8):632-633.
66 Bloor BC,Finander LS,Flacke WE,et al,Effect of clonidine on sympathoadrenal response during sodium nitroprusside hypotension.Anesth Analg.1986;65(5):469-474.
67 Van Aken J,Leusen I,Lacroix E,et al.Influence of converting enzyme inhibition on isoflurane-induced hypotension for cerebral aneurysm surgery.Anaesthesia.1992;47(3):261-264.
2 Newberg LA,Milde JH,Michenfelder JP.Systemic and cerebral effects of isoflurane-induced hypotension in dogs.Anesthsiology,1984;60(6):541-546.
3 Toivonen J,Kaukinen S,Oikkonen M,et al.Effects of deliberate hypotension induced by labetalol on renal function.Eur J Anaesthesiol.1991;8(1):13-20.
4 Nagata N,Matsukado T,Takeshita M,et al.Effect of deliberate hypotension on.renal functions during epidural block plus inhalation anesthesia:a comparison of prostaglandin E1and trimethaphan.Masui.1994;43(10):1472-1477.
5 宋文涛,姚尚荣,包光兴.异丙酚和异氟醚麻醉对硝普钠控制性降压的影响.中华麻醉学杂志,2001:21(2):82-84.
6 Yam akage M,Hirshman CA,Croxton TL.Inhibitory effects of thiopental,ketamin,and propofol on voltage-dependent Ca~(2+)channels in porcine tracheal muscle cells.Anesthesiology.1995;83(6):1274.
7 Cheng EY,Mazzeo A,J.Bosnjak zJ,et al.Direct relaxant effects of intravenous anesthetics on airway smooth muscle.Anesth Analg.1996;83:162.
8 Brockman C,Rasch W.Endocrine stress parameters during TIVA with Remifentanil or sufentanil.Anesth.2000;35(11):685-691.
9 Ledowski,Thomas MD bein,Berthold MD,et al.Neuroendocrine stress Response and Heart Rate Variability:A Comparison of Total Intravavenous Versus Balanced Anesthesia.Anesth Analg.2005;101(6):1700-1705.
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12 Buckle H,Dunbar S,Van Aken H.Remifentanil,a novel,short-acting mu-opioid.Anesth Analg.1996;83:646-651.
13 John BE,Anne ML.Use of remifentanil in infants.Paediatric Anaesthesia.1998;8:437-439.
14 Egan TD,Kern SE,Muir KT,et al.Remifentnail by bolus injection:a safety,pharmacokinetic,pharmacodynamic,and age effect investigation in human volunteers.Br J Anaesth.2004;92:335-343.
15 Richebe P,Rivalan B,Bandouin L,et al.Comparison of the anaesthetic requirement with target-controlled infusion of porpofol to insert the laryngeal tube vs.the laryngeal mask.Eur J Anaesthesiol.2005;22(11):858-863.
16 James G,Peter S.Opioid analgesics in cardiovascular anesthesia.Ariesthesiology.1984;61:73
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4 Newberg LA,Milde JH,Michenfelder JR Systemic and cerebral effects of isoflurane-induced hypotension in dogs.Anesthsiology.1984;60(6):541-546.
5 Eckenhoff JE,Rich JC.Clinical experiences with deliberate hypotension.Anesth Analg.1966;45(1):21-28,
6 Sum DC,Chung PC,Chen WC,et al.Deliberate hypotensive anesthesia with labetalol in reconstructive surgery forscoliosis.Acta Anaesthesiol Sin.1996;34(4):203-207.
7 Khambatta HJ,Stone JG,Matteo RS,et al.Hypotensive anesthesia for spinal fusion with sodium nitroprusside.Spine.1978;3(2):171-174.
8 Precious DS,Splinter W,Bosco D et al.Induced hypotensive anesthesia for adolescent orthognathic surgery patients.J Oral Maxillofac Surg.1996;54(6):680-684.
9 江岩,李淑虹,殷积慧等.艾司洛尔伍用硝普钠用于动脉导管结扎术中降压.临床麻醉学杂志.2000;16(7):355.
10 Abe K,Demizu A,Kamada K.et al.Local cerebral blood flow with prostaglandin Elor or trimethaphan during cerebral aneurysm clip ligation.Can J Anaesth.1991;38(7):831-836.
11 Rao TL,Jacobs K,Salem MR,et al.Deliberate hypotension and anesthetic requirements of halothane.Anesth A nalg.1981;60(7):513-516.
12 Capone AC,Safar P,Stezoski W,et al.Improved outcome with fluid restriction in treatment of uncontrolled hemorrhagic shock.J Am Coll Surg.1995;180(1):49-56.
13 Tuncali B,Karci A,Bacakoglu AK,et al.Controlled hypotension and minimal inflation pressure:a new approach for pneumatic tourniquet application in upper limb surgery.Anesth Analg.2003;97(5):1529-1532.
14 Liu DM,Yeh FC,Chen HI.Pressure-dependent tissue bieeding in cutaneous flap during nitroprusside infusion in the dog.Chin J Physiol.1989;32(2):93-101.
15 Oxorn D.The effect of two levels of hypotension on intraoperative blood loss during total hip arthroplasty performed under epidural anesthesia.Anesth Analg.1993;77(5):1083-1084.
16 Hysing ES,Chelly JE,Doursout MF,et al.Comparative effects of halothane,enflurane,and isoflurane at equihypotensive doses on cardiac performance and coronary and renal blood flows in chronically instrumented dogs.Anesthesiology.1992;76(6):979-784.
17 Valtonen M,Kuttila K,Kanto J,et al.Hypotensive anesthesia for middle ear surgery:a comparison of propofol infusion and isoflurane.Methods Find Exp Clin Pharmacol.1992; 14(5): 383-388.
18 Mulier JP, Wouters PF, Van Aken H, et al. Cardiodynamic effects of propofol in comparison with thiopental: assessment with a transesophageal echocardiographic approach. Anesth Analg. 1991; 72(1): 28-35.
19 Tomiyasu S, Hara T, Hasuo H, et al. Comparative analysis of systemic and coronary hemodynamics during sevoflurane-and isoflurane-induced hypotension in dogs. J Cardiovasc Pharmacol. 1999; 33(5): 741-747.
20 Bernard JM, Pinaud M, Francois T, et al. Deliberate hypotension with nicardipine or nitroprusside during total hip arthroplasty. Anesth Analg. 1991; 73(3): 341-345.
21 Sharrock NE. Bading B, Mineo R, et al. Deliberate hypotensive epidural anesthesia for patients with normal and low cardiac output. Anesth Analg. 1994; 79(5): 899-904.
22 Drummond JC. The lower limit of autoregulation: time to revise our thinking? . Anesthesiology. 1997; 86(6): 1431-1433.
23 Hur SR, Huizenga BA, Major M, et al. Acute normovolemic hemodilution combined with hypotensive anesthesia and other techniques to avoid homologous transfusion in spinal fusion surgery. Spine. 1992; 17(8): 867-873.
24 Endoh H, Honda T, Ohashi S, et al. The influence of nitroglycerin and prostaglandin EI on dynamic cerebral autoregulation in adult patients during propofol and fentanyl anaesthesia. Anaesthesia. 2001; 56(10): 947-952.
25 Milde LN, Milde JH. The cerebral and systemic hemodynamic and metabolic effects of desflurane-induced hypotension in dogs. Anesthesiology. 1991; 74(3): 513-518.
26 Khambatta HJ, Stone JG, Matteo RS. Effect of sodium nitroprusside-induced hypotension on pulmonary deadspace. Br J Anaesth. 1982; 54(11): 1197-1200.
27 Yamakage M, Iwasaki H, Satoh K, et al. Effects of induced hypotension on arterial blood-gases under spontaneous breathing. Acta Anaesthesiol Scand. 1994; 38(4): 368-371.
28 Toivonen J, Kaukinen S, Oikkonen M, et al. Effects of deliberate hypotension induced by labetalol on renal function. Eur J Anaesthesiol. 1991; 8(1): 13-20.
29 Nagata N, Matsukado T, Takeshita M, et al. Effect of deliberate hypotension on renal functions during epidural block plus inhalation anesthesia: a comparison of prostaglandin E1 and trimethaphan. Masui. 1994; 43(10): 1472-1477.
30 Piper SN, Haisch G, Kumle B, et al. Effects of esmolol-and sodium nitroprusside-induced controlled hypotension on hepatocellular integrity in patients undergoing endonasal sinus surgery. Anasthesiol Intensivmed Notfallmed Schmerzther. 2003; 38(12): 781-786.
31 Jordan D, Shulman SM, Miller ED Jr. Esmolol hydrochloride, sodiumnitxoprusside.and isoflurane differ in their ability to alter peripheralsympathetic responses . Anesth Analg. 1993; 77(2): 281-290.
32 Andel D,Andel H,Horauf K,et al.The influence of deliberate hypotension on splanchnic perfusion balance with use of either isoflurane or esmolol and nitroglycerin.Anesth Analg.2001 Nov;93(5):1116-20.
33 Kick O,Van Aken H,Wouters PF,er al.Vital organ blood flow during deliberate hypotension in dogs.Anesth Analg.1993;77(4):737-742.
34 王心田,佘守章,谢富生等.异丙酚、异氟醚复合控制性降压用于颅脑手术的观察.中华麻醉学杂志.1999;19(6):346-347.
35 李树人,韩如泉,槐庆元等.七氟醚对犬血流动力学影响的实验研究.中华麻醉学杂志.1996;16(11):543.
36 Nakamura K,Toda H,Hatano Y,et al.Comparison of the direct effects of sevoflurane,isoflurane and halothane on isolated canine coronary arteries.Can J Anaesth.1993;40(3):257-261.
37 秋维,蔡惠敏,梁裕等.异丙酚与安氟醚在脊柱侧凸畸形后路矫正术麻醉中的比较.中华麻醉学杂志.1999;19(11):660-663.
38 Mikhail MS,Thangathurai D,Thaker KB,et al.Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin.J Cardiothorac Vasc Anesth.2000;14(5):565-570.
39 文亮,毕敏.硝普钠控制性降压及其并发症.中华麻醉学杂志.1991;11(1):33-34.
40 Ali SS,Dubikaitis A,al Qattan AR.The relationship between end tidal carbon dioxide and arterial carbon dioxide during controlled hypotensive anaesthesia.Med Princ Pract.2002;11(1):35-37.
41 Suttner SW,Lang K,Boldt J,et al.The influence of hyperoxic ventilation during sodium nitroprusside-induced hypotension on skeletal muscle tissue oxygen tension.Anesthesiology.2002;96(5):1103-1108.
42 Massoud TF,Hademenos G J,Young WL,et al.Can induction of systemic hypotension help prevent nidus rupture complicating arteriovenous malformation embolization?:analysis of underlying mechanism achieved using a theoretical model.AJNR Am J Neuroradiol.2000;21(7):1255-1267.
43 Degoute CS,Ray MJ,Manchon M,et al.Remifentanil and controlled hypotension;comparison with nitroprusside or esmolol during tympanoplasty.Can J Anaesth.2001;48(1):20-27.
44 Mikhail MS,Thangathurai D,Thaker KB,et al.Echocardiographic assessment of coronary blood flow velocity during controlled hypotensive anesthesia with nitroglycerin.J Cardiothorac Vasc Anesth.2000;14(5):565-570.
45 Pakulski C,Nowicki R,Kowalczyk P.et al.The influence of controlled hypotension on splanchnic mucosal perfusion using gastric tonometry in patients undergoing resection of meningioma.Med Sci Monit.2002;8(1):CR28-30.
46 李虹,张秀芝,张亚军等.硝普钠和硝酸甘油联合用于控制性降压的实验观察.中华麻醉学杂志,1999;19(9):526.
47 Hersey SL,O'Dell NE,Lowe S,et al.Nicardipine versus nitroprusside for controlled hypotension during spinal surgery in adolescents.Anesth Analg.1997;84(6):1239-1244.
48 Takeda S,Ozawa Y,Tomaru T.Haemodynamic effects of hypotension induced by KRN2391and nicardipine in isoflurane anaesthetized dogs.Can J Anaesth.1997;44(9):1002-1007.
49 Schoffstall JM,Spivey WH,Gambone LM,et al.Effects of calcium channel blocker overdose-induced toxicity in the conscious dog.Ann Emerg Med.1991;20(10):1104-1108.
50 Quartaroli M,Gambini F,Tarter G,et al.The hemodynamic effects of lacidipine in anesthetized dogs:comparison with nitrendipine,amlodipine,verapamil,and diltiazem.J Cardiovasc Pharmacol.1991;18(3):326-336.
51 Tobias JD,Berkenbosch JW.Initial experience with dexmedetomidine in paediatric-aged patients.Paediatr Anaesth.2002;12(2):171-175.
52 Noma T,Ichinohe T,Kaneko Y.Inhibition of physiologic stress responses by regional nerve block during orthognathic surgery under hypotensive anesthesia.Oral Surgy Oral Surg Oral Med Oral Pathol Oral Radiol Endod.1998;86(5):511-515.
53 Kikuta Y,Ohiwa E,Okada K,et al.Clinical application of diadenosine tetraphosphate (Ap4A:F-1500)for controlled hypotension.Acta Anaesthesiol Scand.1999;43(1):82-86.
54 Sato J,Saito S,Takahashi T,et al.Sevoflurane and nitrous oxide anaesthesia suppresses heart rate variabilities during deliberate hypotension.Eur J Anaesthesiol.2001;18(12):805-810.
55 Endoh H,Honda T,Ohashi S,et al.The influence of nicardipine-,nitroglycerin-,and prostaglandin E(1)-induced hypotension on cerebral pressure autoregulation in adult patients during propofol-fentanyl anesthesia.Anesth Analg.2002;94(1):169-173.
56 张诗海,曾帮雄,金士翱等.降钙素基因相关肤控制性降压对大鼠肝血流及氧供氧耗的影响.中华麻醉学杂志.1998;18(6):350-352.
57 张诗海,曾帮雄,金士翱等.降钙素基因相关肤控制性降压对大鼠血流动力学和器官血流的影响.中华麻醉学杂志.1997;17(2):94-96.
58 Guy J,Hindman BJ,Baker KZ,et al.Comparison of remifentanil and fentanyl in patients undergoing craniotomy for supratentorial space-occupying lesions.Anesthesiology.1997;86(3):514-524.
59 Schuttler J,Albrecht S,Breivik H,et al.A comparison ofremifentanil and alfentanil in patients undergoing major abdominal surgery.Anaesthesia.1997;52(4):307-317.
60 Baker KZ,Ostapkovich N,Sisti MB,et al.Intact cerebral blood flow reactivity during remifentanil/nitrous oxide anesthesia.J Neurosurg Anesthesiol.1997;9(2):134-140.
61 Hogue CW Jr,Bowdle TA,O'Leary C,et al.A multicenter evaluation of total intravenous anesthesia with remifentanil and propofol for elective inpatient surgery.Anesth Analg.1996;83(2):279-285.
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63 Kazmaier S,Hanekop GG,Buhre W,et al.Myocardial consequences ofremifentanil in patients with coronary artery disease.Br J Anaesth.2000;84(5):578-583.
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