头高体位联合适度控制性低血压对内窥镜鼻窦手术出血量的影响

Effects of Reverse Trendelenburg Position Combined with Moderate Controlled Hypotension on Bleeding Volume in Endoscopic Sinus Surgery

目的探讨头高体位联合适度控制性低血压对内窥镜鼻窦手术出血量的影响。方法选取2020年10月至2022年3月在银川市第一人民医院行鼻内窥镜手术的成年患者82例,随机数字表法分为对照组和联合组;所有患者全身麻醉后行足背动脉穿刺置管测压。对照组采用加深麻醉及泵注硝普钠的方法将平均动脉压降至55~65 mmHg或降至基础值的70%;联合组采用加深麻醉的方法将平均动脉压降至75 mmHg左右或降至基础值的80%~85%,同时采用头高15°的体位。观察两组患者麻醉前、插管后手术前、控制性降压后及术后的心率、平均动脉压,在手术开始后5、15、30和45 min进行术野质量评分,记录术野质量评分、手术时间、术中出血量、尿量及苏醒时间。结果控制性降压后,联合组的心率低于对照组,平均动脉压高于对照组(P均<0.001);与对照组比较,联合组各观测时点的术野质量评分低(P<0.001);和对照组比较,联合组的手术时间短、术中出血量少、尿量多(P均<0.001);两组恶心、呕吐发生情况和苏醒时间比较差异无统计学意义(P均>0.05)。结论头高体位联合适度控制性低血压可以降低内窥镜鼻窦手术出血量,对患者苏醒时间无影响。

Objective To investigate the effect of reverse Trendelenburg position combined with moderate controlled hypotension on the amount of bleeding in endoscopic sinus surgery.Methods A total of 82 patients undergoing endoscopic sinus surgery were randomly divided into combined application group and control group.All patients received general anesthesia and dorsal pedis artery puncture to measure pressure.In the control group,the average arterial pressure was reduced to 70%of the baseline or to 55-65 mmHg by deepening anesthesia and pumping sodium itroprusside.In the combined application group,the average arterial pressure dropped to 80%-85%of the baseline value or about 75 mmHg by deepening anesthesia and combining the position of 15 degrees head height.The heart rate and mean arterial pressure of the two groups were observed before anesthesia,after intubation and before operation,after controlled hypotension and after operation.The operation field quality score was assessed at 5,15,30 and 45 min after the beginning of the surgery respectively.The operation field quality score,operation time,intraoperative bleeding,urine volume and anesthesia recovery time were recorded.Results The heart rate in the combined application group was lower than that in the control group after controlled hypotension,and the mean arterial pressure in the combined application group was higher than that in the control group(P all<0.001).Compared with the control group,the combined application group had lower scores of operation field quality(P<0.001),shorter operative time,less bleeding and more urine(P all<0.001).There was no difference in nausea and vomiting,anaesthesia recovery time between the two groups(P all>0.05).Conclusion Reverse trendelenburg position combined with mild controlled hypotension can reduce the amount of bleeding in endoscopic sinus surgery,and has no effect on the quality of recovery.