硝酸甘油复合短效β受体阻滞剂对鼻内镜手术的控制性降压作用

Effect of Controlled Hypotension by Nitroglycerin Combined with Smolol in Endoscopic Nasal Surgery

目的评估硝酸甘油复合短效β受体阻滞剂艾司洛尔对鼻内镜手术的控制性降压效果。方法选择择期鼻内镜手术患者60例,随机分为未降压组、硝酸甘油组和艾司洛尔复合硝酸甘油组,每组20例,观察各组麻醉前、降压后10、20、30min平均动脉压、心率和术野质量。术毕记录各组手术出血量、手术时间和硝酸甘油用量。结果Ⅱ、Ⅲ组术中出血量、手术时间均较I组减少,差异有统计学意义。在开始降压后10、20、30、40min4个时点,Ⅱ、Ⅲ组MAP较Ⅰ组降低,Ⅱ组HR较Ⅰ明显增加,Ⅲ组HR较Ⅰ组和Ⅱ组明显降低,差异有统计学意义,Ⅱ组术野质量评分在开始降压后10、20、30min3个时点优于Ⅰ组,Ⅲ组术野质量评分在降压后4个时点均优于Ⅰ组,并且在开始降压后40min的时点优于Ⅱ组。结论硝酸甘油复合短效β受体阻滞剂控制性降压技术应用于鼻内镜手术,可实现平稳降压,防止反射性的心率增快,明显减少出血量、改善术野质量、缩短手术时间,是鼻内镜手术较为理想的降压方法。

Objective To evaluate the effect of controlled hypotension with nitroglycerin and esmolol in the operation of endoscopic nasal surgery. Methods 60 patients undergoing selective endoscopic nasal surgery were randomly divided into three groups averagely： control group （group Ⅰ ）, controlled hypotension with nitroglycerin group（ group Ⅱ ） , controlled hypotension with nitroglycerin and esmo- 1ol group （group Ⅲ ）. Every group has 20 patients. Mean artery pressure （MAP） , HR, scores of surgical field quality（SSFQ） were recorded before anaesthesia and 10,20,30,40 minutes after anaesthesia. After the operation, bleeding eapacity, operation time and dosage of nitroglycerin were recorded too. Results The bleeding capacity and operation time in group Ⅱ and Ⅲ was significantly less than that in group Ⅰ （P〈0.05）. 10,20,30,30 minutes after anaesthesia , the MAP in group Ⅱ or Ⅲ were significantly higher than that in group Ⅰ , HR in group Ⅱ were significantly higher than that in group Ⅰ , HR in Ⅲ were significantly higher than that in group Ⅰ or Ⅱ. SSFQ in group Ⅱ were significantly better than that in group Ⅰ 10,20,30 minutes after anaesthesia. SSFQ in group Ⅲ were significantly better than that in group Ⅰ 10,20,30,40 minutes after anaesthesia. SSFQ in group Ⅲ were significantly better than that in group Ⅱ 40 minutes after anaesthesia. Conclusion The controlled hypotension with nitroglycerin and esmolol used in endoscopic nasal surgery can decrease blood pressure smoothly, reduce the bleeding capacity and operation time obviously, prevent reflex enhancement of HR, reduce myocardial oxygen consumption. It is a fine method for hypotension in endoscopic nasal surgery.