鼻内镜手术局部麻醉的临床观察

Local anesthesia in endoscopic sinus surgery

目的探讨内镜鼻腔鼻窦手术采用局部麻醉的可行性和优点。方法随机选择2000年1月～2007年12月的810例采用局部麻醉施行的内镜鼻腔鼻窦手术进行临床观察。采用视觉模拟评分(visual analogous scale,VAS)评价麻醉效果,并观察了手术时间、术中出血量、手术并发症、术后6个月的临床随访表现、手术费用及患者对手术的总体评价。结果 VAS总体评分是(3.18±0.46)分,其中无痛与轻微疼痛占78.28%(634/810),中度疼痛占16.71%(136/810),重度疼痛占5.01%(40/810)。手术出血量(43.25±27.46)ml,手术时间(41.14±9.479)min,手术并发症发生率为1.78%,术后6个月治愈率为78%(612/810),手术费用4000～6000元。患者对住院手术治疗过程总体评价(9.28±2.21)分。结论患者对手术的总体评价良好。在严格掌握手术适应证,手术技巧熟练,具备较为先进的手术器械的情况下,绝大多数内镜鼻腔鼻窦手术可以在局部麻醉下施行。

OBJECTIVE To investigate the feasibility of endoscopic sinus surgery under local anesthesia.METHODS A total of 810 patients underwent endoscopic sinus surgery from January 2000 to December 2007 with complete follow-up data were included in this study.Validity of anesthesia was evaluated using VAS（visual analogous scale）.Operation time,bleeding quantity during operation,operation therapeutic efficacy,hospitalization cost and patient＇s evaluation to the operation were recorded.RESULTS The mean VAS score of local anesthesia was 3.18±0.46.Cases with no pain and mild pain accounted for 78.28%,with moderate pain 16.71%,and with severe pain 5.01%.The average bleeding quantity during operation,operation time,complication incidence,cure rate at 6 months after operation,hospitalization cost,patients＇ evaluation in local anesthesia were（43.25±27.46）ml,（41.14±9.479） min,1.78%,78%,4000～6000 yuan（RMB）,9.28± 2.21 respectively.CONCLUSION For the endoscopic sinus surgery,most cases can be operated under local anesthesia if the indication were selected correctly and the sophisticated skills and advanced instrument were available.