全凭静脉麻醉与吸入麻醉对慢性鼻窦炎患者鼻内窥镜手术中肺顺应性的影响

Effects of total intravenous anesthesia and inhaled anesthesia on pulmonary compliance during endoscopic sinus surgery in patients with chronic sinusitis

目的比较慢性鼻窦炎患者行鼻内窥镜手术(ESS)时,应用全凭静脉麻醉(TIVA)与吸入麻醉两种麻醉维持方法对患者肺顺应性的影响。方法入选2020年9-12月于首都医科大学附属北京同仁医院诊断为慢性鼻窦炎,拟择期在全身麻醉下行ESS的患者80例。由计算机产生随机序列号,将患者分为TIVA组和吸入麻醉组,每组40例。TIVA组持续静脉泵注丙泊酚+瑞芬太尼维持麻醉;吸入麻醉组持续吸入七氟烷+瑞芬太尼维持麻醉。比较2组患者麻醉诱导后置入喉罩前、置入喉罩后5、30、60 min及手术结束即刻的肺顺应性、气道峰压、平台压、气道阻力;比较2组患者麻醉诱导前和术中平均动脉压(MAP)、心率及术中出血量和出血速度、术后麻醉恢复室停留时间、术后6 h内随访结果。结果 TIVA组与吸入麻醉组患者置入喉罩前、置入喉罩后5、30、60 min及手术结束即刻的肺顺应性比较[(70±15) ml/cm H_(2)O(1 cm H_(2)O=0.098 k Pa)比(67±16) ml/cm H_(2)O、(68±14) ml/cm H_(2)O比(69±12) ml/cm H_(2)O、(64±14) ml/cm H_(2)O比(63±12) ml/cm H_(2)O、(63±12) ml/cm H_(2)O比(57±11) ml/cm H_(2)O、(60±14) ml/cm H_(2)O比(61±14) ml/cm H_(2)O],差异均无统计学意义(均P> 0.05)。2组患者以上各时点气道峰压、平台压、气道阻力比较差异均无统计学意义(均P> 0.05)。2组患者麻醉诱导前和术中MAP、心率及术中出血量和出血速度、麻醉恢复室停留时间比较,差异均无统计学意义(均P> 0.05)。2组患者术后6 h内不良反应发生率组间比较差异均无统计学意义(均P> 0.05)。结论对于慢性鼻窦炎行ESS患者,采用TIVA和吸入麻醉两种麻醉维持方法对术中肺顺应性的影响没有明显差异。

Objective To compare the effects of total intravenous anesthesia( TIVA) and inhaled anesthesia on pulmonary compliance in patients with chronic sinusitis during endoscopic sinus surgery( ESS).Methods From September to December 2020,80 patients with chronic sinusitis undergoing elective ESS under general anesthesia in Beijing Tongren Hospital,Capital Medical University were selected. Random serial numbers were generated by computer. The patients were divided into TIVA group and inhaled anesthesia group,with 40 cases in each group. In TIVA group,propofol and remifentanil were continuously intravenous pumped to maintain anesthesia;in inhaled anesthesia group,sevoflurane and remifentanil were continuously inhaled to maintain anesthesia. The lung compliance,peak airway pressure,plateau pressure and airway resistance of the two groups were compared before laryngeal mask airway( LMA) insertion,and 5,30,60 min after LMA insertion as well as immediately after operation. The mean arterial pressure( MAP),heart rate before anesthesia induction and during operation,intraoperative blood loss and bleeding velocity,postoperative stay time in recovery room and follow-up results within 6 h after operation were compared between the two groups. Results There were no significant differences in lung compliance between TIVA group and inhaled anesthesia group before LMA insertion and 5,30,60 min after LMA insertion as well as immediately after operation[( 70 ± 15) ml/cm H_(2)O vs( 67 ± 16) ml/cm H_(2)O,( 68 ±14) ml/cm H_(2)O vs( 69 ± 12) ml/cm H_(2)O,( 64 ± 14) ml/cm H_(2)O vs( 63 ± 12) ml/cm H_(2)O,( 63 ± 12) ml/cm H_(2)O vs( 57 ± 11) ml/cm H_(2)O,( 60 ± 14) ml/cm H_(2)O vs( 61 ± 14) ml/cm H_(2)O]( all P > 0. 05). There were no significant differences in peak airway pressure,plateau pressure and airway resistance between the two groups at the above time points( all P > 0. 05). There were no significant differences between the two groups in MAP,heart rate before anesthesia induction,blood loss and bleeding velocity during operation,and stay time in anesthesia recovery room( all P > 0. 05). There was no significant difference in adverse reactions between the two groups within 6 h after operation( all P > 0. 05). Conclusion For patients with chronic sinusitis undergoing ESS,there is no significant difference between TIVA and inhaled anesthesia in lung compliance during operation.