硝酸甘油复合艾司洛尔控制性降压在鼻内窥镜手术中的应用  

Application of Deliberated Hypotension by Nitroglycerin Combined with Esmolol in Endoscopic Nasal Surgery

作　　者：吴萍[1] 郝国明[1] 郑良杰[1] 佘赛娟[1] 

机构地区：[1]汕头市中心医院中山大学附属汕头医院麻醉科,广东汕头515031

出　　处：《国际医药卫生导报》2006年第11期52-53,共2页International Medicine and Health Guidance News

摘　　要：目的探讨硝酸甘油复合艾司洛尔控制性降压技术在鼻内窥镜手术中减少出血量、缩短手术时间的效果。方法选择择期行鼻内窥镜手术病人60例,随机分成三组。Ⅰ组为对照组;Ⅱ组为硝酸甘油控制性降压组;Ⅲ组为硝酸甘油复合艾司洛尔控制性降压组,每组20例。所有病人均用咪唑安定、丙泊酚、芬太尼、阿曲库铵行麻醉快速诱导,经口腔气管内插管,接麻醉机控制通气;用异氟醚、芬太尼、阿曲库铵维持麻醉;术中监测平均动脉血压(MAP)、HR、SpO2、ECG、出血量、手术时间、尿量。结果Ⅱ、Ⅲ组出血量和手术时间少于Ⅰ组,差异有显著性(P<0.05);Ⅱ组的心率明显高于术前,差异有显著性(P<0.05),Ⅰ、Ⅲ组的心率较术前无明显差异。结论硝酸甘油复合艾司洛尔控制性降压技术应用于鼻内窥镜手术,明显减少出血量、缩短手术时间,防止反射性的心率增快,降低心肌耗氧量,是鼻内窥镜手术较为理想的麻醉方法。Objective To explore the effect of deliberated hypotension with nitroglycerin and esmolol in reducing the operation time and blood loss of endoscopic nasal surgery.Methods 60 patients undergoing selective endoscopic nasal surgery were randomly divided into three groups averagely： control group （group Ⅰ）, deliberated hypotension with nitroglycerin group（group Ⅱ）, deliberated hypotension with nitroglycerin and esmolol group （group Ⅲ）. All patients were induced with midazolam, propofol, fentanyl and atracurium, mechanically ventilated after tracheal intubation by mouth. All patients were maintained anesthesia with isoflurance, fentanyl and atracurium. Monitoring mean artery pressure （MAP）, HR, SpO2, ECG, bleeding capacity, operation time and urine capacity. Results The bleeding capacity and operation time in groupⅡ and Ⅲ was significantly less than that in group Ⅰ （P〈0. 05）. The HR during the operation was significantly higher than that of pre-operation in group Ⅱ （P〈0. 05）. It was no significantly difference of HR in group Ⅰ or Ⅲ between the same points. Conclusion The deliberated hypotension with nitroglycerin and esmolol used in endoscopic nasal surgery can decrease the bleeding capacity and operation time obviously, prevent reflex enhancement of HR, reduce myocardial oxygen consumption. It is a better method for endoscopic nasal surgery.

关 键 词：硝酸甘油 艾司洛尔 控制性降压 鼻内窥镜手术 麻醉 

分 类 号：R614[医药卫生—麻醉学]