控制性降压对鼻窦手术患者出血以及术后认知功能的影响  

Influence on blood loss and postoperative cognitive function of controlled hypotension in sinus surgery

作　　者：霍苗[1] 张倩[2] 王亚峰 邱小平[4] HUO Miao;ZHANG Qian;WANG Yiafeng(Department of Anesthesiology, Shaanxi People's Hospital Xi’an 710068)

机构地区：[1]陕西省人民医院麻醉科,西安710068 [2]陕西省人民医院烧伤整形美容外科,西安710068 [3]广西壮族自治区区医院麻醉科,南宁530021 [4]陕西省人民医院耳鼻喉科,西安710068

出　　处：《陕西医学杂志》2019年第4期495-498,共4页Shaanxi Medical Journal

基　　金：陕西省卫生厅科研基金资助项目(2008H03)

摘　　要：目的:研究控制性降压对鼻窦手术患者的出血影响以及术后认知功能的影响,得到最佳的降压范围。方法:80例行鼻窦手术的患者为研究对象,随机分成两组,对照组不采取降压措施,降压组给予硝酸甘油和艾司洛尔联合控制性降压,通过调节不同的降压幅度20%、25%,监测患者术中的心率、平均动脉压、心电图(ECG,监测ST段变化),比较患者的手术时间、苏醒时间和术中出血量。术后通过简易智力状态检查量表评分(MMSE)评估患者的认知功能并比较患者满意度。结果:降压组手术时间、苏醒时间和术中出血量均明显少于对照组(P<0.05);降压幅度25%患者术中出血量少于降压幅度20%,差异有统计学意义(P<0.05),手术时间和苏醒时间也有所缩短,医生术中满意度高。术后通过简易智力状态检查量表评分(MMSE)评估患者的认知功能,降压组和对照组对比差异不明显(P>0.05)。结论:鼻窦手术中实施控制性降压的降压幅度为基础血压的25%时能很好的降低术中出血量,缩短手术及苏醒时间,并且对患者认知功能无影响,手术者术中及患者术后满意度高。Objective :To investigate the optimal blood pressure range through the influence on blood loss and postoperative cognitive function of controlledhypotension in sinus surgery. Methods:80 patients who received sinus surgery were selected as the subjects and divided into the observation group and the control group. In the control group, there was no depressurization measures were taken, and the patients in the test group were treated with nitroglycerin and esmolol with 20%, 25% depressurizing range respectively. Heart rate, Mean arterial pressure, ECG especially changes in ST segment were monitored during the operation. Besides, the operative time, postoperative recovery and sober time and blood loss were compared. Also, to evaluate the cognitive function in different groups, the MMSE scores were recorded. Patient satisfaction were investigated andcompared. Results:The operative time, sober time and blood loss in the depressurizing group were significantly less than those in the control group( P <0.05). Especially the blood loss in the test group with 25% depressurizing range was significantly less than 20% depressurizing range ( P <0.05), the operative time and sober time were also shorter. Meanwhile, the patient satisfaction after surgery was higher than others in different groups. There’s was no significant difference of the MMSE score between the depressurizing group and the control group( P >0.05). Conclusion:Controlled hypotension with 25% depressurizing range on the basis blood pressure in sinus surgery can reduce the operative blood loss and shorten the sober time with no cognitive impairment, which can achieve good postoperation patient satisfaction.

关 键 词：控制性降压 鼻窦手术 出血 平均动脉压 认智功能 简易知力状态检查量表评分 

分 类 号：R765.4[医药卫生—耳鼻咽喉科]