两种麻醉维持方式对合并高血压病患者鼻内窥镜手术出血量的影响  

Comparison of bleeding volume during endoscopic sinus surgery in patients with hypertension under total intravenous anesthesia and combined intravenous with inhaled anesthesia

作　　者：王宏梗[1] 林群[2] 陈东生[3] 黄方[4] 洪育明[4] 黄建强[4] 

机构地区：[1]福建医科大学附属第二医院麻醉科,泉州市362000 [2]福建医科大学附属第一医院麻醉科 [3]南京军区福州总医院麻醉科 [4]福建医科大学附属第二医院耳鼻咽喉科

出　　处：《临床麻醉学杂志》2016年第9期885-888,共4页Journal of Clinical Anesthesiology

基　　金：泉州市科技计划项目(2008Z22)

摘　　要：目的：观察两种麻醉维持方式对合并原发性高血压病患者行鼻内窥镜手术出血量的影响。方法选择Ⅰ或Ⅱ期原发性高血压病患者40例,男25例,女15例,年龄35~54岁,ASA Ⅰ或Ⅱ级,患者随机分为两组,每组20例。A 组为全凭静脉麻醉组；B 组为静-吸复合麻醉组。两组麻醉诱导方法相同,气管插管后,A 组麻醉维持以丙泊酚及瑞芬太尼持续泵注至手术结束前5 min 停药；B 组麻醉维持以吸入七氟醚,手术结束前5 min 停药。手术期间维持 BIS 值在40~60。麻醉诱导插管后至手术开始通过调节麻醉深度并辅以硝酸甘油及艾司洛尔适当降低 BP 并进行高容量血液稀释。记录术中出血量及手术时间。分别在手术开始前30 min（T0）、手术开始后30 min（T1）、90 min （T2）及手术结束后30 min（T3）采血测动脉血气、静脉血乳酸浓度、凝血功能。结果 A 组手术出血量（175±32）ml 明显少于 B 组（212±41）ml （P 〈0.05）。两组患者手术时间差异无统计学意义。手术开始前15 min,两组 MAP 逐渐下降、HR 逐渐减慢,未见反跳性心率增快现象。两组患者各时点动脉血 pH、PaCO 2、静脉血乳酸浓度、凝血酶原时间及活化部分凝血活酶时间差异无统计学意义。结论采用全凭静脉麻醉有助于减少原发性高血压病患者鼻内窥镜手术中出血量。Objective To compare the bleeding volume during endoscopic sinus surgery in pa-tients with hypertension under total intravenous anesthesia or combination of intravenous with inhaled anesthesia.Methods Forty adult patients with hypertension （ASA Ⅰ or Ⅱ）,male 25 and female 1 5,aged 35-54 years,agreed to be on electively endoscopic sinus surgery,were divided randomly into two groups（group A and group B,n =20 each）.All patients were injected intravenously with fenta-nyl,propofol and cisatracurium during the induction of general anesthesia.During the maintenance stage of the general anesthesia,patients in group A were injected intravenously with propofol,and patients in group B were inhaled with sevoflurane until 5 minutes before the end of the operation.BIS was 40-60 during the operation in the two groups.After induction of anesthesia and tracheal intubation,ni-troglycerin and esmolol were given to adjust blood pressure and hypervolemic hemodilution was performed.. Bleeding volume and operation duration were recorded at the end of the operation.The arterial blood gas, blood lactate and coagulation function were monitored 30 minutes before the operation （T0 ）,30 minutes （T1 ）and 90 minutes after the operation beginning （T2 ）and 30 minutes after the end of the operation （T3 ）. Results Bleeding volume in group A was significantly less than that in group B （P 〈0.05）.Fifteen minutes before the operation,the MAP of all the patients in two groups was controlled slowly to 60 mm Hg.Com-pare to those at T0 ,there was no significant difference in the arterial blood pressure,blood lactate and coag-ulation function at T1 ,T2 and T3 .Conclusion During the endoscopic sinus surgery with intravenous anes-thesia for patients with hypertension,the bleeding volume was less than that with inhalation anesthesia.

关 键 词：高血压病 鼻内窥镜手术 出血量 静脉麻醉 吸入麻醉 

分 类 号：R614.2[医药卫生—麻醉学]