不同降压水平对高血压老年患者鼻内镜手术的影响  

The effect of different control hypotension levels on endoscopic sinus surgery in hypertension elderly patient

作　　者：金约西[1] 吴文灿[2] 姜艾芬[1] 叶文炼[1] 

机构地区：[1]温州医学院附属眼视光医院麻醉科,浙江温州325027 [2]温州医学院附属眼视光医院眼科,浙江温州325027

出　　处：《中国内镜杂志》2011年第9期917-920,共4页China Journal of Endoscopy

摘　　要：目的探讨不同控制性降压水平对高血压老年患者鼻内镜手术的影响。方法选择60例择期行鼻内镜下眼-鼻相关手术的高血压病老年患者,随机分成A组[平均动脉压(MAP)降低20%]、B组MAP降低30%)、C组(MAP降低40%),n=20。观察记录入室后10min(T1)、降压15min(T2)、30min(T3)、停止降压后15min(T4)时胸导联心电图ST段改变,桡动脉和颈内静脉血行血气分析;并进行Fromme术野质量评分;同时记录手术中尿量、出血量和手术时间及围术期控制性降压并发症。结果 C组在T2、T3时ST段改变较A、B组明显(P<0.05);A组在T2和T3的Fromme术野质量评分高于B、C组(P<0.05);B、C组的手术时间要短于A组(P<0.05);B、C组的术中出血量少于A组(P<0.05);A、B两组T2和T3动脉血乳酸浓度(LAC)较C组低(P<0.05);A、B组在T2和T3时点动脉-颈内静脉血氧含量差(Da-jvO2)和脑氧摄取率(CERO2)低于C组(P<0.05)。结论降低MAP30%使术野出血少,缩短手术时间,无明显副作用,可安全用于高血压老年患者眼-鼻相关鼻内镜手术。[Objective] To investigate the effect of different control hypotension levels on endoscopic sinus surgery in hypertension elderly patient.[Methods] For 60 hypertension elderly patients who would undergo the endoscopic sinus surgery,randomly divided into group A [mean arterial pressure（MAP） reduced by 20%],group B（MAP reduced by 30%）,group C（MAP reduced by 40%） n =20.The chest lead ECG ST segment changes.Radial artery and internal jugular venous blood gas analysis,Fromme score of operative field quality（FS-OFQ） was evaluated at different time such as the time of entering the operation room,15 min after control hypotension,30 min after control hypotension,15 min after cessation of control hypotension.Meanwhile,urine volume,bleeding volume,operation time and the complication of control hypotension during the operation were observed.[Results] The ST segment changes in group C at T2 and T3 were significantly change as compared those in group A and group B（P 0.05）;Fromme score of operative field quality in group A at T2 and T3 were significantly higher compared those in group B and group C（P 0.05）.The operation time in group A was longer than group B and group C（P 0.05）.Compared with group A,the bleeding volume was more few in group B and group C（P 0.05）.The arterial blood lactate concentration（LAC） in group C at T2 and T3 were significantly lower as compared those in group A and group B（P 0.05）.The artery-jugular venous oxygen content difference（Da-jvO2） and cerebral oxygen uptake rate（CERO2） in group A and group B at T2 and T3 were significantly lower as compared those in group C（P 0.05）.[Conclusion] MAP reduced by 30% have clear surgical field,shorten operation time,no side effect,and was more safe on eye-nose related endoscopic sinus surgery in hypertension elderly patient.

关 键 词：控制性降压 老年患者 高血压 鼻内镜 

分 类 号：R765[医药卫生—耳鼻咽喉科]