不同方法控制性降压对鼻内镜手术患者内脏灌注及术中出血量的影响  

Effect of controlled hypotension with different drugs combined with acute hypervolemic hemodilution on bleeding volume and gastrointestinal perfusion in nasal endoscopic surgery

作　　者：焦赫娜[1] 任飞[1] 蔡宏伟[1] 郭曲练[1] 

机构地区：[1]中南大学湘雅医院麻醉科,湖南长沙410008

出　　处：《南方医科大学学报》2009年第6期1163-1165,1169,共4页Journal of Southern Medical University

基　　金：湖南省卫生厅科研基金(B2007025)

摘　　要：目的研究不同方法控制性降压对内窥镜下鼻窦手术患者内脏灌注及术中出血量的影响。方法择期内窥镜下鼻窦手术患者30例,随机分为A组(普通全麻组)、B组(硝普钠控制性降压)和C组(硝酸甘油控制性降压),每组10例。在静吸复合全麻下,桡动脉穿刺置管监测平均动脉血压(MAP),B、C组于麻醉后行急性高血容量血液稀释,然后于手术开始前15min分别予硝普钠或硝酸甘油复合异氟醚吸入行控制性降压,使MAP降至50～55mmHg,并维持至术毕,A组不进行扩容和控制性降压。B、C组于麻醉后(T0)、降压开始时(T1)、降压30min(T2)、降压60min(T3)、停降压30min(T4)[A组未降压,在与降压组相对应的时间即麻醉后(T0)、手术开始前15min(T1)、手术开始后15min(T2)、手术开始后45min(T3)、手术结束后30min(T4)]时分别记录HR、MAP,并采集动脉血行血气分析,记录PaCO2和pH值。胃二氧化碳张力仪测量PgCO2,根据血气值计算pHi。记录手术出血量和手术时间。结果B、C组比A组出血量少,手术时间短,C组出血量比B组少。3组病人pHi、PgCO2组内前后比较及组间比较均无统计学意义。结论硝酸甘油或硝普钠控制性降压联合急性高血容量稀释时如采用合理的措施,MAP降至50～55mmHg时并不一定会导致胃肠道循环低灌注和氧合障碍。内窥镜下鼻窦手术控制性降压可减少手术中出血量,且使用硝酸甘油降压比使用硝普钠降压减少岀血效果更好。Objective To investigate the effect of controlled hypotension using different drugs on gastrointestinal perfusion and bleeding volume in nasal endoscopic surgery. Methods Thirty ASA class I or II patients scheduled for nasal endoscopic surgery were randomized into three groups, including a routine general anesthesia group （group A） and two controlled hypotension groups （groups B and C）. After anesthesia induction, anesthesia was maintained with 1%-2% isoflurane and vecuronium. ECG, mean arterial blood pressure （MAP）, heart rate （HR）, SpO2 and PETCO2 were continuously monitored. TRIP tonometry catheter 14 F was inserted into the stomach and connected to Tonocap （Datex-Ohmeda, Finland ）. In groups B and C, hypotension was induced with isoflurane （1%-2%） and sodium nitroprusside （0.3-3 μg.kg^-1 .min^-1）, and with isoflurane （1%-2%） and glonoine （0.5-5μg.kg^-1.min^-1）, respectively, and the MAP was reduced to 50-55 mmHg in 10-15 min. In groups B and C, blood samples were taken for blood gas analysis after anesthesia （T0）, after acute hypervolemic hemodilution （T0, at 30 and 60 min after controlled hypotension （T2 and T3）, and 30 min after recovery fi＇om hypotension （T4）. In group A, blood samples were taken at different time points in the perioperative period. Results The patients in groups B and C had smaller bleeding volume than those in group A. HR was decreased after moderate acute hypervolemic hemodilution, and increased after controlled hypotension （T2 and T3） in comparison with that at T1 to a level similar to that at To. No significant changes were found in pHi at T2 and T3 in comparison with that at T1 in the three groups. Conclusion When appropriate measures are taken, induced hypotension at 50-55 mmHg does not necessarily produce disturbance in gastrointestinal perfusion. Induced hypotension with glonoin can decrease the bleeding volume better than sodium nitroprusside in nasal endoscopic surgery.

关 键 词：控制性降压 鼻窦炎/外科学 鼻息肉/外科学 内镜 内脏灌注 出血量 硝普钠 硝酸甘油 

分 类 号：R614[医药卫生—麻醉学]