不同方式控制性降压对鼻内窥镜手术出血的影响

THE EFFECTS OF DIFFERENTTYPE CONTROLLED HYPOTENSIONS ON BLEEDING DURING ENDOSCOPIC SURGERY FOR NASAL SINUS

①目的探讨硝酸甘油复合艾司洛尔控制性降压技术在鼻窦内窥镜手术中应用的效果.②方法鼻中隔偏曲、慢性鼻窦炎、鼻息肉手术病人30例,年龄20～50岁,ASAⅠ～Ⅱ级.随机分为对照组、单纯硝酸甘油控制性降压组、硝酸甘油复合艾司洛尔控制性降压组,每组10例.术中监测有创平均动脉压、心率、出血量、手术时间及手术医生对手术视野满意度.③结果对照组和硝酸甘油组出血量比较差异无显著性,硝酸甘油复合艾司洛尔组明显少于对照组(F=6.19,q=4.97,P<0.01);手术时间三组比较差异无显著性;硝酸甘油组心率明显高于术前(t=5.499,P<0.01),另外两组术中心率较术前无明显变化;硝酸甘油复合艾司洛尔组手术满意度明显高于其他两组(Hc=7.45,q=3.41、3.10,P<0.05).④结论硝酸甘油复合艾司洛尔控制性降压技术是鼻内窥镜手术的理想麻醉技术.

Objective To investigate the effect of controlled hypotension induced by nitroglycerin and esmolol on blood loss during endoscopic operation on nasal sinus. MethOds Thirty patients, aged 20 to 50 years old, ASA grade Ⅰ- Ⅱ ,with deviated nasal septum, chronic sinusitis, and nasal polyp, were divided into three groups： control group, nitroglycerin group and nitroglycerin combined with esmolol （NE） group, 10 patients in each group. The invasive mean arterial pressure（MAP）, heart rate （HR）, blood loss, operation time, and the degree of surgeons satisfaction on the operative field were monitored and recorded. Results The difference of blood loss between the control group and nitroglycerin group was not statistically significant, while the blood loss of theNEgroup was significantly less than that of the control group （F=6. 19,q=4. 97,P〈0.01）. No significant difference was noted in terms of operation time among the three groups. HR in the nitroglycerin group was faster than that before operation（t=5. 499,P〈0. 01）. The satisfaction on operative field in NE group was higher than the other two groups（Hc =7.45; q=3.41,3.10; P〈0.05）. Conclusion Controlled hypotension induced by combination of nitroglycerin and esmolol is an ideal anesthesia for endoscopic operation on nasal sinus.