控制性降压对鼻内镜手术视野及脑氧供需平衡状况的影响

The effects of controlled hypotension at different levels on the definition of surgical field and metabolism

目的观察不同水平控制性降压对鼻内镜手术视野清晰度及脑氧供需平衡的影响。方法将240例临床择期手术患者随机分成4组,每组均为60例。组1(G1)控制性降压水平为原平均动脉压的64%,组2(G2)为70%,组3(G3)为80%,组4(G4)未施降压,作为对照。监测颈内静脉血氧饱和度、动静脉乳酸浓度及其他血生化指标,同时根据Fromm e术野质量评分表由同一术者进行术野质量评分。结果G1、G2、G3组平均动脉压降至原血压的64%、70%、80%,维持1 h,上述各组代谢指标与对照组间无显著性差异,降至64%术野清晰度各组间及与对照组间有显著性差异。结论吸入性全麻下用0.01%硝普钠(SNP)+安氟醚(ENF),血压降至原血压的64%,维持1 h,在供氧充分的情况下,对氧供需平衡无明显影响,但术野清晰度最佳,该方法是安全有效的。

Objective The clinical experiment was designed for observing the effects of controlled hypotension at different levels on cerebral metabolism and the definition of surgical field. Methods 240 ASA Grade patients were randomly allocated to one of four groups（ each group n= 60）. Hypotension was induced by sodium nitroprusside in group 1 [ mean arterial pressure（MAP） =64% of former MAP], group 2 （MAP = 70% of former MAP）, and group 3 （MAP = 80% of former MAP）. Group 4 （control） was on no hypotension. Oxygen saturation in ternal jugular vein （SjO2 ） were monitored, meanwhile the scores of surgical field quality （SSFQ） were assessed according to fromme surgical field qulity list. Results Hypotesion caused a moderate decrease in metabolism index, but had no significant difference, either among three groups or during the procedure;on the contrary, the definition of surgical field has significant difference. Conclusion There is no significant effect on oxygen balance with controlled hypotension at MAP = 64% of former MAP,but the definition of surgical field is the best.