两种不同麻醉方法用于鼻内镜下鼻咽血管瘤切除术中术野质量的比较

Comparison of surgical field quality under two different anesthesia for endoscopic juvenile nasopharyngeal angiofibroma resection

目的比较两种不同控制性降压方法用于鼻内镜下鼻咽血管纤维瘤(juvenile nasopharyngeal angiofibro-ma,JNA)切除术对术野质量的影响。方法 48例鼻内镜下JNA切除术患者随机分为S组(n=24)与T组(n=24)。S组使用七氟烷复合瑞芬太尼,T组靶控输注丙泊酚复合瑞芬太尼行控制性降压全麻。诱导后分别调整丙泊酚及吸入七氟烷浓度使脑电双频指数(BIS)值稳定于40～50,以瑞芬太尼10～30μg/(kg·h)输注速度使平均动脉压(MAP)维持于50～65mmHg。术中由术者行术野质量评分。结果本组46例在预定情况下将MAP、BIS值控制于目标水平。术中各时点两组间MAP差异无统计学意义,但T组平均手术时间小于S组[(96±19)minvs.(114±23)min,P=0.019],心率慢于S组,术野质量评分优于S组。结论与复合吸入七氟烷相比,使用瑞芬太尼复合丙泊酚控制性降压全麻,达相似降压水平下能提供更好的术野质量。

Objective To compare the influence of two different types of anesthesia for endoscopic juvenile nasopharyngeal angiofibrema （JNA） resection in terms of surgical field quality. Methods Forty-eight patients who had endoscopic JNA resection were randomly divided into Group S （n=24） with combination of remifentanil and sevoflurane and the Group T （n=24） with remifentanil and targeted controlled infusion of propofol for anesthesia and hypotension control. The concentration of propofol and inhalational sevoflurane were adjusted to induce the BIS value between 40 and 50 following induction. MAP within 50-65 mmHg were acquired with remifentanil infusion at speed of 10-30 μg/（kg ·h） during surgery. The quality of surgical field was evaluated by the surgeons. Results The MAP and BIS value of 46 patients were acquired as expected. There were no significant difference of MAP between the two groups while shorter average duration of surgery and slower HR as well as better quality of surgical field in Group T than Group S. Conclusion The combination of remifentanil and propofol is more appropriate than remifentanil and sevoflurane to control hypotension for endoscopic resection of JNA under general anesthesia.