局部麻醉与全身麻醉下行鼻内镜鼻窦手术治疗慢性鼻-鼻窦炎的临床效果对比

Comparison of clinical efficacy between local anesthesia and general anesthesia in endoscopic sinus surgery for chronic rhino-sinusitis

目的对比局部麻醉与全身麻醉下行鼻内镜鼻窦手术治疗慢性鼻-鼻窦炎的临床效果。方法慢性鼻-鼻窦炎病变不超过中鼻甲基板、需行鼻内镜手术的患者200例,按随机数字表法分为局麻组和全麻组,各100例,分别在局部麻醉、全身麻醉下行鼻内镜鼻窦手术,比较两组术中出血量、手术时间、麻醉效果、手术并发症发生率、术后鼻腔渗血量、术后麻醉不良反应发生率、术后疼痛度、住院费用、患者评价、术后3个月近期疗效等。结果局麻组手术时间、术中出血量、手术并发症发生率、术后鼻腔渗血量、术后麻醉不良反应发生率、住院费用、术后疼痛评分均少于或低于全麻组(P<0.05)。两组患者评价得分比较、麻醉效果、术后3个月近期疗效比较,差异无统计学意义(P>0.05)。结论在局部麻醉与全身麻醉下鼻内镜手术治疗慢性鼻-鼻窦炎的麻醉效果、近期疗效相当,且局部麻醉手术时间短、术中出血量少,术后并发症及不良反应少,疼痛轻、费用低。

Objective To compare the clinical efficacy between local anesthesia and general anesthesia in endoscopic sinus surgery for chronic rhino-sinusitis. Methods Two hundred patients with chronic rhino-sinusitis, whose lesions were not beyond the middle nasal methyl plate ,required the endoscopic sinus surgeries. The patients were divided into local anesthesia group and general anesthesia group using random number table,with 100 cases in each group. Local anesthesia group and general anesthesia group underwent endoscopic sinus surgery under local anesthesia and general anesthesia respectively. The intraoperative blood loss, operative duration, anesthesia efficacy, incidence of surgical complications, volume of postoperative nasal errhysis, incidence of postoperative anesthesia adverse reactions, postoperative pain, hospitalized cost,patient＇s evaluation,short-term efficacy after three months of surgery were compared between two groups. Results The operative duration,intraoperative blood loss,incidence of surgical complications ,volume of postoperative nasal errhysis,incidence of postoperative anesthesia adverse reactions, hospitalized cost, postoperative pain score of local anesthesia group were lower or less than those of general anesthesia group （P 〈 0.05 ）. There was no significant difference in the patient＇s evaluation, anesthesia efficacy or short-term efficacy after three months of surgery between two groups （P 〉 0.05）. Conclusion For chronic rhino-sinusitis, the endoscopic sinus surgery under local anesthesia obtains similar anesthesia efficacy and short-term efficacy after three months of surgery as the surgery under general anesthesia. And it has shorter operative duration, less intraoperative blood loss,lower incidences of postoperative complications and anesthesia adverse reactions after surgery, and less postoperative pain and hospitalized cost.