鼻腔支架与鼻腔填塞对鼻中隔矫正术后患者麻醉恢复影响的前瞻性随机对照研究

A Prospective Randomized Controlled Study on the Effect of Nasal Stents and Nasal Packing on Anesthesia Recovery After Nasal Septoplasty

目的比较鼻中隔矫正术后鼻腔支架与膨胀海绵鼻腔填塞对麻醉恢复期的影响。方法选择2021年10月~2022年5月因鼻中隔偏曲行鼻中隔偏曲矫正术59例,随机分为鼻腔支架组(n=29)和膨胀海绵组(n=30),比较2组患者麻醉恢复期血流动力学、拔管质量、呛咳和屏气等情况。结果鼻腔支架组麻醉恢复期平均动脉压(mean arterial pressure,MAP)和心率(heart rate,HR)均明显低于膨胀海绵组(F=4.284,P=0.043;F=9.673,P=0.003);MAP拔管后即刻(T1)较麻醉前(T0)下降,在拔管后5 min(T2)、10 min(T3)明显较麻醉前(T0)升高,差异有统计学意义(均P=0.000);HR拔管后5 min(T2),拔管后10 min(T3)明显高于拔管后即刻(T1)(P=0.000,P=0.007),与麻醉前(T0)差异无显著性(P>0.05);组别和时间存在交互效应(F=4.977,P=0.004;F=3.028,P=0.037)。鼻腔支架组拔管质量评分明显优于膨胀海绵组(Z=-4.403,P=0.000);2组患者患者拔管后10 min内血氧饱和度差异无统计学意义(t=1.210,P=0.231);鼻腔支架组拔管后呛咳、屏气评分优于膨胀海绵组,差异有统计学意义(Z=-3.182,P=0.001);鼻腔支架组麻醉后监护时间中位数14.0 min,明显短于于膨胀海绵组16.3 min(Z=-2.291,P=0.022)。结论鼻腔支架作为鼻中隔矫正术后新型填塞方式较传统鼻腔填塞可以减轻麻醉拔管后应激反应,降低拔管风险。

Objective To explore the effect of nasal stent and nasal packing on anesthesia recovery by comparing the subjective and objective indicators during anesthesia extubation.Methods A total of 59 patients with deviation of nasal septum between October 2021 and May 2022 were randomly divided into nasal stent group(n=29)and Merocel group(n=30).The hemodynamics,extubation quality,coughing and breath holding in the recovery period of anesthesia between the two groups were compared.Results The mean arterial pressure(MAP)and heart rate(HR)in the nasal stent group were significantly lower than those in the Merocel group(F=4.284,P=0.043;F=9.673,P=0.003);the MAP decreased immediately after extubation(T1)as compared with that before anesthesia(T0),and increased significantly at 5 min after extubation(T2)and 10 min after extubation(T3)as compared with that before anesthesia(T0)(all P=0.000).The HR 5 min after extubation(T2)and 10 min after extubation(T3)were significantly higher than those immediately after extubation(T1)(P=0.000,P=0.007),but had no significant difference as compared with those before anesthesia(T0)(P>0.05).There were interaction effects between group and time(F=4.977,P=0.004;F=3.028,P=0.037).The extubation quality score of the nasal stent group was lower than that of the Merocel group(Z=-4.403,P=0.000).There was no significant difference in blood oxygen saturation within 10 min after extubation between the two groups(t=1.210,P=0.231).The scores of cough and breath hold after extubation in the nasal stent group were significantly lower than those in the Merocel group(Z=-3.182,P=0.001).The median monitoring time after anesthesia in the nasal stent group was 14.0 min,which was significantly shorter than that in the Merocel group(16.3 min),with statistically significant difference(Z=-2.291,P=0.022).Conclusion Compared with traditional nasal packing,nasal stents can reduce the stress response after anesthesia extubation and the risk of extubation.