七氟醚静吸复合麻醉在高血压患者鼻内窥镜术中的体会

Combined Intravenous with Inhalation Sevoflurane Anesthesia for Nasal Endoscopic Surgery in Hypertensive Patient

目的探讨七氟醚静吸复合麻醉在高血压患者鼻内窥镜手术中的安全性和可行性。方法择期鼻内窥镜手术患者30例，ASAI或Ⅱ级，无凝血功能障碍。随机双盲分为A、B两组各15例，A组为七氟醚静吸复合麻醉组，B组为全凭静脉麻醉组。麻醉诱导为咪唑安定0．06mg／kg，依托咪酯0．3mg／kg，维库溴铵0．10—0．15mg／kg，芬太尼4μg／kg；麻醉维持：A组采用七氟醚、异丙酚、维库溴铵；B组选用异丙酚、维库溴铵、芬太尼。术中A组手术开始后逐渐增加七氟醚浓度至目标血压（平均动脉压，MAP65—75mmHg）。术中连续监测有创血压（BP）、心率（HR）、呼吸末二氧化碳分压（PETCO2），心电图（ECG）和末梢脉搏血氧饱和度（SPO2）。记录时点为手术开始前即刻（T0），手术20min（T1），手术结束后10min（T2）；手术结束后送麻醉恢复室（PACU）30rain后抽动脉血测定血气分析值，并记录术毕睁眼时间，拔除气管导管时间和手术时间，观察有无呼吸抑制、嗜睡、躁动、恶心呕吐等不良反应。结果与Tn时比较A组T1时MAP显著下降（P〈0．01），T2回升，T1时A组MAP较B组显著下降（P〈0．01），A组气管插管和鼻内窥镜置入期间血流动力学稳定，麻醉苏醒迅速安全，无术后并发症及不良反应，B组气管插管和鼻内窥镜置入期间，血压明显升高，麻醉恢复较慢，并有2例恶心呕吐，3例嗜睡。结论七氟醚静吸复合麻醉在高血压患者鼻内窥镜手术中能有效控制血压，减少出血量，缩短手术时间，术后苏醒迅速、安全，并发症及不良反应少等优点，很适合高血压患者鼻内窥镜手术的麻醉要求。

Objective To investigate the safety and feasibility of sevoflurane combined intravenous with inhalation anesthesia （ CIIA ） for nasal endoscope surgery in hypertensive patients. Methods Thirty hypertension patients without thromboasthenia undergoing selective nasal endoscope surgery（ American Association of Anesthetists classify brand Ⅰ or Ⅱ ） were randomly divided into two groups：group A（ 15 eases） and group B（ 15 eases）. Both groups were induced by 0. 05 mg/kg of midazolam,0.3 mg/kg of etomidate ,0.1 mg/kg of veeuronium bromide and 4 μg/kg of fentanyl. Anesthesia was maintained in group A by using sevoflurane, propofol and veeuronium bromide, and in Group B using propofol, veeuronium bromide and fentanyl. Intraoperative sevoflurane concentration was gradually increased to objective pressure（ MAP 65 -75 mm Hg） in group A, and the invasive blood pressure, heart rate, respiratory carbon dioxide partial pressure at the end, electrocardiogram and peripheral pulse oxygen saturation were continuously monitored at next time points：the beginning time of the surgery （T0 ）, the time when it went on 20 rain （T1 ） and ten rain after the surgery（ T2 ）. When the operation was over for 30 min, arterial blood was pumped to get blood gas analysis, the time of eyes-open and eyes-closed trachea cannula taking away and the total time of surgery were recorded. The respiratory depressing, lethargy, restlessness, nausea and vomiting or other untoward effects were observed. Results MAP（ T1 ） decreased obvi- ously as compared with it at To （ P 〈 0.01 ） and rose again at T2. MAP（ T1 ） in group A decreased obviously compared with group B（P 〈0.0l ）. In group A,when a trachea cannula and nasal endoscope was in,hemodynamies was stable. Analepsia was very safe and quick and had no postoperative complications. But in group B, blood pressure significantly rose, recover of anesthesia was rather slow and there were nausea and vomiting（2 eases） and lethargy（ 3 eases）. Conclusion Sevoflurane CIIA has good effects on controlling blood pressure, reducing the amount of bleeding, shortening the surgery time, making analepsia safe and quick, and having less untoward effects on hypertensive patients in nasal endoscope surgery. It can meet well anesthesia demand of patients with nasal endoscope surgery.