控制性降压联合白眉蛇毒血凝酶用于鼻内窥镜手术的临床观察

Clinical observation of controlled hypotension and combined use of hemocoagulase for injection in ESS

目的观察控制性降压（con—trolled hypotension，CH）联合白眉蛇毒血凝酶（hemocoagulase for injection，HFI）应用于鼻内窥镜手术的安全性和临床效果。方法鼻内窥镜手术患者40例，ASAⅠ～Ⅱ级，随机分为两组，Ⅰ组20例，在手术开始前静脉输注白眉蛇毒血凝酶2ku，切皮后在持续静脉泵注异丙酚复合瑞芬太尼全凭静脉麻醉下以硝酸甘油行控制性降压；Ⅱ组（对照组）20例，未行CH＋HFI外，余操作同Ⅰ组。实施控制性降压时平均动脉压波动于60～70mmHg（1innHg=0．133 kPa）。观察两组血流动力学、纤维蛋白原（FIB）、部分凝血活酶时间（APTT）及凝血酶原时间（PT）、血红蛋白（Hb）、术中出血量、术野满意度的改变。结果与Ⅱ组比较，Ⅰ组出血量明显减少（P〈0．05），术野满意度显著提高（P〈0．05）；Ⅰ组术中MAP显著降低，HR显著加快，与术前和Ⅱ组比较，差异有显著性（P〈0．05）；Ⅰ组术后Hb水平较对照组高（P〈0．05）；两组间凝血功能参数无统计学差别（P〉0．05）。结论鼻内窥镜手术中控制性降压联用白眉蛇毒血凝酶不仅能更有效减少术中出血量和提高术野满意度，而且对凝血功能无明显影响。

Objective To investigate the effects of controlled hypotension with combined use of hemocoagulase on perioperative hemorrhage and coagulation function in patients undergoing ESS. Methods Forty patients undergoing ESS were randomly divided into two groups, Group Ⅰ and group Ⅱ （n =20） , and they were under the same anesthesia. Group I that hemoeoagulase for injection iv was given before anesthesia induction, with infusion of nitroglycelin for controlled hypotension followed under remifentanil - diprivan intravenous anesthesia. Group Ⅱ were not given nitroglycerin or hemocoagulase respectively. The controlled hypotension was targeted for MAP 60 - 70 mm Hg. The changes in MAP, HR, Hb, FIB , PT,APTT and the view satisfactions during surgery, as well as the amount of blood loss. Results The amount of blood loss were lower in group I compared with that in group Ⅱ（P 〈 0.05）. And improved the view satisfactions during surgery（P 〈 0.05 ） ;Statistically significant changes of lower MAP and faster HR in group I during operation than that before operation and in group Ⅱ （ P 〈 0.05 ）. The Hb level in group I was higher than that in group Ⅱ（P 〈0.05）. The blood coagulation of two groups showed no significant differences（P 〉 0.05 ）. Conclusion Controlled hypotension and combined use of hemocoagulase in patients undergoing ESS can reduce the perioperative hemorrhage and improve the view satisfactions during surgery, yet has no adverse effects on patient＇s coagulation.