七氟烷用于鼻内镜手术中控制性降血压的效果观察

Effects of sevoflurane controlled hypotension in patients undergoing functional endoscopic sinus surgery

目的 观察七氟烷用于鼻内镜手术中控制性降血压的安全性和有效性.方法 40例择期在全身麻醉下行鼻内镜手术的患者,按随机数字表均分为丙泊酚组（P组）和七氟烷组（S组）,P组持续泵注瑞芬太尼0.2 μg·kg-1·min-1复合丙泊酚4～6 mg·kg-1·min-1维持麻醉；S组持续泵注瑞芬太尼0.2 μg·kg-1·min-1,持续吸入七氟烷2％ ～3％,两组术中均维持平均动脉压（MAP）为65～75 mm Hg.记录降压前（T1）、降压后5 min（T2）、降压后30 min（T3）、手术结束时（T4）及手术结束后5 min （T5）时的MAP、心率（HR）,并记录术毕睁眼时间、苏醒拔除气管导管时间、手术时间和术中出血量.观察有无呼吸抑制、嗜睡、躁动、恶心呕吐等不良反应.并根据Fromme术野质量评分组表进行术野评分.结果 与T1相比,两组组内MAP（F=73.68）、HR（F=24.60）在其它时点差异有统计学意义（P＜0.05）.两组组间各时点MAP（t=0.90）、HR（t=1.00）差异无统计学意义（P＞0.05）.两组拔除气管导管时间（t=0.44）、手术时间（t=1.23）、术野质量评分（t=0.43）、术中出血量（t=0.58）差异无统计学意义（P＞0.05）.结论 在鼻内镜全麻手术中应用七氟烷静吸复合瑞芬太尼控制性降压安全有效,不良反应少,值得推广应用.

Objective To observe the security and efficacy of sevoflurane inhalation in combination with remifentanil controlled hypotension in patients undergoing functional endoscopic sinus surgery.Methods Forty pa tients undergoing elective functional endoscopic sinus surgery were randomly divided into propofol group （group P）and sevoflurane group（group S）.In group P,patients received remifentanil 0.2μg · kg-1 · min-1 and propofol 4 ～6mg · kg-1 · min-1 intravenously,those in group S received remifentanil 0.2pg · kg-1 · min-1 and continuous inhalation of sevoflurane 2 ～ 3%,the end-tidal concentration was 1.1 ～ 1.7MAC.MAP was retained at 65 ～ 75 mmHg in the two groups.MAP and HR were recorded before controlled hypotension （T1）,5min after controlled hypotension （T2）,30min after controlled hypotension（T3）,the termination of surgery（T4） and 5min after the termination of surgery（T5）.Record the patient opening eyes time,wake extubation time,duration of surgery,blood loss.Also observed with or without respiratory depression,drowsiness,restlessness,nausea,vomiting and other adverse reactions.The same surgery fell surgical field quality rating according to Fromme operative field score table.Results Compared with T1,MAP（F =73.68） and HR（F =24.60） decreased significantly（P 〈 0.05） at the other time points.There was no statistically significant difference in MAP（t =0.90） and HR（t =1.00） at the same time points between the two groups （P 〉 0.05）.Extubation time （t =0.44）,duration of operation （t =1.23）,operative field score （t =0：43） and blood loss （t =0.58） has no significant differences （P 〉 0.05）.Conclusion Inhalation hypotension by sevoflurane is feasible and safe in the functional endoscopic sinus surgery.It shows good quality of surgical field and less adverse reactions.