七氟烷控制性降压在高血压患者鼻内窥镜手术的探讨

Discussion of sevoflurane in deliberate hypotension of hypertension patients for endoscopic sinus surgery

目的探讨七氟烷控制性降压在高血压患者鼻内窥镜手术(ESS)中应用的合理性和可行性。方法选择择期ESS患者64例,ASA Ⅰ～Ⅱ级,无凝血功能障碍,随机分为乌拉地尔组(A组)、硝酸甘油组(B组)、硝酸甘油伍用艾司洛尔组(C组)和七氟烷组(D组),每组16例。降压组术中使MAP控制在术前基础血压的65%～70%,记录各观察指标变化,并进行对照分析。结果 A组降压后平稳,但降压幅度小;B组降压明显,但心率明显增加(P<0.01);C组降压效果确切,但操作繁琐;D组用药简单,降压效果确切。4组术中心肌耗氧量均明显减少(P<0.01)。结论七氟烷静吸复合麻醉控制性降压用于高血压患者ESS降压操作简便,控制性降压的同时还能提供完善的镇痛和降低心肌氧耗,是一种良好的控制性降压方法。

Objective To investigate the feasibility and security of Sevoflurane in deliberate hypotension of hypertension patients for endoscopic sinus surgery（ESS）.Methods Sixty-four patients of non-coagulation dysfunction with ASA Ⅰ～Ⅱundergoing ESS were randomly divided into urapidil group（A group）,nitroglycerin group（B group）,nitroglycerin combined with esmolol group（C group）and sevoflurane group（D group）,16 cases of each group.Controlled hypotension patients make the MAP preoperative blood pressure about 65%～70%,recorded the observed changes,and control.Results Group A,patients deliberate hypotension were smooth,but a small step-down rate;in Group B,Patients′heart rate were obviously increased after deliberate hypotension（P0.01）;in Group C,the effect of deliberate hypotension was exact,but to the operation process was cumbersome;in Group D the use was simple,the effect of deliberate hypotension and analgesic was exact;the opening time and extubation time of patients in four group after operation didn′t changed significantly（P0.01）.Patients′myocardial oxygen consumption were decreased obviously in all groups（P0.01）.Conclusion Sevoflurane combine with intravenous anesthesia in deliberate hypotension of hypertension patients for endoscopic sinus surgery can provide perfect analgesia and reduce the blood loss and operation time significantly reduce without affecting the awakenness,and which is a good method of controlled hypotension.