不同水平控制性低血压在鼻窦镜手术中的应用效果比较  

Efficacy of different levels of controlled hypotension in endoscopic sinus surgery

作　　者：石海辉 于巍 秦佳巍 柴洪波 张志娟 Shi Haihui;Yu Wei;Qin Jiawei;Chai Hongbo;Zhang Zhijuan(Department of Anesthesiology,Lianzhou People's Hospital,Lianzhou 513400,Guangdong Province,China)

机构地区：[1]连州市人民医院麻醉科,广东省513400

出　　处：《中国基层医药》2021年第1期76-80,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的:比较不同水平控制性低血压在鼻窦镜手术中的应用效果及安全性。方法:选取2016年3月至2018年2月在连州市人民医院行慢性鼻窦炎鼻窦开放手术的患者90例,采用随机数字表法分成三组,每组30例,对三组患者术中实施控制性降血压,以入院至手术前1 d的平均动脉压值作为基础血压,术中血压控制性降低20%(A组)、控制性降低35%(B组)、控制性降低50%(C组)。三组手术方式及手术人员相同。比较三组术中术野清晰情况、出血量、血气分析及生命体征变化情况、总手术时间、苏醒时间、拔管时间、术者对手术环境的满意程度、住院时间。结果:三组均顺利完成手术,三组的血气分析各主要参数、苏醒时间、拔管时间等均差异无统计学意义(t=1.863、1.772、1.513、1.221、1.376、1.512,均P>0.05);C组术野清晰情况最优,术者对手术环境的满意程度最高,满意度为93.33%(28/30),明显高于A组的53.33%(16/30)和B组的70.00%(21/30)(χ^(2)=8.226,P<0.01;χ^(2)=4.136,P<0.05);C组出血量最少[(56±18)mL],与B组和A组比较,均差异有统计学意义(t=3.863、9.102,均P<0.05、P<0.01);C组总手术时间最短[(58±11)min],与B组及A组比较,均差异有统计学意义(t=3.025、7.983,P<0.05、P<0.01)。结论:鼻窦镜手术中实施控制性降血压是安全且需要的,而血压控制性降低50%更有利于提供清晰的术野,更有利于手术操作,可提高治疗效果。Objective To investigate the efficacy and safety of different levels of controlled hypotension in endoscopic sinus surgery.Methods Ninety patients with chronic sinusitis who underwent open sinus surgery in Lianzhou People's Hospital from March 2016 to February 2018 were included in this study.These patients were randomly divided into three groups(n=30/group)to receive open sinus surgery with blood pressure controlled at different levels:20%(group A),35%(group B),and 50%(group C)lower than the basic blood pressure,which was the mean arterial pressure from admission to 1 day before surgery.Operation methods and personnel were the same in the three groups.The operation field clarity,amount of blood loss,blood gas analysis parameters,vital signs,total operation time,recovery time,time to extubation,patient satisfaction to operation environment and hospital stay were compared among the three groups.Results Open sinus surgery was successful in all three groups.There were no significant differences in main parameters of blood gas analysis,recovery time,and time to extubation among groups(t=1.863,1.772,1.513,1.221,1.376,1.512,all P>0.05).The operation field in the group C was the most optimal,and patient satisfaction to operation environment in the group C[93.33%(28/30)]was significantly higher than that in the group A[53.33%(16/30)]and group B[70.00%(21/30)](χ^(2)=8.226,P<0.01;χ^(2)=4.136,P<0.05).The amount of blood loss in the group C[(56±18)mL]was the lowest,and it was significantly lower than that in the groups B and A(t=3.863,9.102,P<0.05,P<0.01).The operation time in the group C was the shortest[(58±11)min],and it was significantly shorter than that in the groups B and A(t=3.025,7.983,P<0.05,P<0.01).Conclusion Controlled hypotension in endoscopic sinus surgery is safe and necessary,and controlling blood pressure to 50%of basic blood pressure is more conducive to providing a clear surgical field to facilitate operation,thereby improving therapeutic efficacy.

关 键 词：降压 控制性 鼻窦疾病 内窥镜检查 麻醉 低血压 七氟烷 舒芬太尼 右美托咪定 出血 

分 类 号：R765.9[医药卫生—耳鼻咽喉科]