不同控制性降压方法用于鼻内镜手术效果的比较

Comparison of the different methods of controlled hypotension in endoscopic nasal surgery

目的比较不同控制性降压方法在鼻内镜手术中的应用效果。方法选择择期行鼻内镜手术的ASAⅠ-Ⅱ级患者60例,随机分为A组（术中给予硝酸甘油＋艾司洛尔）、B组（术中给予硝酸甘油＋地尔硫）,每组30例,根据患者的血压、心率（HR）变化调整降压药用量,使血压降低不超过原水平的40%,HR维持在60~80次/min。比较两组麻醉前,插管后,降压后15、30min和降压结束后10min的HR、平均动脉压（MAP）以及手术时间和出血量,评估术野质量。结果两组在降压后15min和30min的HR、MAP与麻醉前、插管后比较,有显著性差异（P〈0.05）;两组间比较,控制性降压效果无显著性差异（P〉0.05）,出血量、手术时间和术野质量评分均无显著性差异（P〉0.05）。结论鼻内镜手术中采用硝酸甘油复合地尔硫行控制性降压,其临床效果与硝酸甘油复合艾司洛尔相近。

Objective To compare the effects of different controlled methods of hypotension in nasal endoscopic surgery.Methods Sixty patients undergoing nasal endoscopic surgery under American Society of Anesthesiologists（ASA） level Ⅰ to level Ⅱ anesthesia were selected,and the patients were divided into two groups at random,with 30 cases each in group.In group A a combination of nitroglycerin and esmolol was used,and in Group B a combination of nitroglycerin and diltiazem was used.The doses of hypotensor were adjusted according to the change in blood pressure（BP） and heart rate（HR）,by controlling the reduction of the blood pressure not exceeding 40% of the original blood pressure,and maintaining the heart rate between 60 to 80 beat per minute.Then mean arterial pressure（MAP）,the duration of surgery and the amount of hemorrhage,which were measured before anerthesia,were compared after intubation,15 and 30 minutes after lowering of BP and 10 minutes after the end of blood pressure lowering.Measurements were used to evaluate the scores of surgical field quality.Results Comparing HR and MAP in two groups 15 minutes and 30 minutes after lowering of BP before anesthesia and after intubation,the difference was significant（P0.05）;Comparing the two groups,the effect of both controlled methods of lowering BP on the patients there was no significant difference（P0.05）.The amount of hemorrhage,duration of surgery and the scores of surgical field quality showed no significant differences（P0.05）.Conclusion The combination of nitroglycerin and diltiazem for controlled lowering of BP showed similar clinical effects and similar results of the method of controlled lowering of BP with the combination of nitroglycerin and esmolol,therefore,the combination of nitroglycerin and diltiazem can be used as a new method of controlled lowering of BP.