硝酸甘油控制性降压在鼻内镜术全凭静脉麻醉中的应用

Controlled hypotension with Nitroglycerin during intranasal endoscope surgery with total intravenous anesthesia

目的:探讨硝酸甘油控制性降压在鼻内镜术全凭静脉麻醉中的应用效果。方法:鼻息肉、鼻窦炎行鼻内镜手术共64例,ASAⅠ或Ⅱ级,随机分为不用硝酸甘油的对照组32例和使用硝酸甘油的观察组32例,均用瑞芬太尼复合丙泊酚全凭静脉麻醉,观察组诱导插管后静脉泵注硝酸甘油,起始剂量为1μg/(kg·min),调节泵速使收缩压维持在95～105mmHg。观察术前、降压过程中的SBP和HR变化,计录瑞芬太尼、丙泊酚用量,手术时间、患者苏醒时间和术野质量评估。结果:观察组降压程度明显大于对照组(P<0.01),瑞芬太尼、丙泊酚用量和手术时间明显小于对照组(P<0.01),两组患者的苏醒时间差异无统计学意义(P>0.05),术野质量观察组优于对照组(P<0.01)。结论:全凭静脉麻醉下使用硝酸甘油控制性降压在鼻内镜手术中降压平稳,出血量少,术野清楚,效果明显,并可减少麻醉药用量和手术时间,值得推广。

Objective： To investigate the effects of controlled hypotension with Nitroglycerin during intranasal endoscope surgery with total intravenous anesthesia. Methods： A total of 64 adult patients, American Society of Anesthesiologists physical statusⅠ or Ⅱ, scheduled for operations were randomly allocated into the control group without Nitroglycerin （n=32） and the observe group with Nitroglycerin （n=32）. Anesthesia were performed with remifentanil and propofol by total intravenous anesthesia for all patients. After tracheal intubate succeed, Nitroglycerin was injected intravenously by pump. Systolic pressure was maintained from 95 to 105 mmHg by regulating speed of pump at initial dose 1 μg/（kg·min）. Observed the variation of SBP and HR before operation, during the course of controlled hypotension. The parameters including total dosage of remifentanil and propofol, persistence time of operation and resuscitation, assessment of quality of operation visual fields. Results： The range of controlled hypotension was significantly greater in the observe group than control group （P0.01）. The total dosage of remifentanil and propofol, persistence time of operation were significantly less in the observe group than control group （P0.01）. No significant differences were found in the time of resuscitation. The quality of operation visual fields was significantly better in the observe group than control group （P0.01）. The resurgence of the time difference was no statistically significant in the two groups （P0.05）. Conclusion： The procedure of controlled hypotension with Nitroglycerin during nasal endoscope with total intravenous anesthesia is stable. The total amount of bleeding is smaller and the operation visual fields is more clear. Besides, it can be decrease the total dosage of anesthetics and persistence time of operation by this way. Therefore, it is worth to be generalizated.