全凭静脉麻醉对鼻窦黏膜严重病变的慢性鼻窦炎患者手术视野的影响  

Total intravenous anesthesia improves surgical field visibility during surgery for chronic rhinosinusitis with severe nasal mucosal lesions

作　　者：陈恺铮 夏俊明 沈霞 王德辉 顾瑜蓉 CHEN Kaizheng;XIA Junming;SHEN Xia;WANG Dehui;Gu Yurong(Department of Anesthesiology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China;Department of Otorhinolaryngology,Eye&ENT Hospital,Fudan University,Shanghai 200031,China)

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [2]复旦大学附属眼耳鼻喉科医院耳鼻喉科,上海200031

出　　处：《中国眼耳鼻喉科杂志》2021年第5期350-354,共5页Chinese Journal of Ophthalmology and Otorhinolaryngology

摘　　要：目的观察全凭静脉麻醉(TIVA)对术前鼻窦黏膜严重病变的慢性鼻窦炎患者行鼻内镜手术(ESS)时视野的影响。方法50例美国麻醉医师协会(ASA)Ⅰ~Ⅱ级择期行功能性鼻内镜手术的慢性鼻窦炎且Lund-Mackay(LM)评分≥12分的成年患者,随机分为TIVA组(n=25)和地氟醚组(D组,n=25)。术毕分别由手术医师和麻醉医师评估手术视野;记录术中出血量和输液量;记录手术结束至对呼唤有反应时间、拔除喉罩时间、定向力恢复时间和麻醉恢复室逗留时间;记录围手术期以下时间点的心率和血压变化:麻醉前(t_(0))、手术开始后10 min(t_(10))、手术结束(t_(end))、送入麻醉后恢复室(t_(pacu))、拔管即刻(t_(extu))和出麻醉后恢复室(t_(dis))。结果手术医师采用数字量表评分法评价手术视野,TIVA组优于D组(3.6分vs.5.2分,P<0.0001);麻醉医师采用Beozaart评分,TIVA组手术视野优于D组(2.3分vs.3.2分,P<0.0001)。TIVA组[200(150,450)mL]术中出血量少于D组[350(250,425)mL],P=0.00087;TIVA组[1000(500,1000)mL]补液少于D组[1000(1000,1250)mL],P=0.00081。TIVA组定向力恢复时间早于D组(15.1 min vs.20.3 min,P=0.001),麻醉后恢复室逗留时间短于D组(21.6 min vs.25.2 min,P<0.05)。2组间围术期心率变化差异无统计学意义(P>0.05),但血压变化差异有统计学意义(P<0.0001)。结论TIVA可改善LM评分≥12的慢性鼻窦炎患者ESS视野,且利于患者术后定向力恢复和加快麻醉后恢复室的周转。Objective To evaluate the effect of total intravenous anesthesia(TIVA)on surgical field visibility in patients with chronic rhinosinusitis(CRS)with high-grade inflammatory disease(preoperative Lund-Mackay score 12)during endoscopic sinus surgery(ESS).Methods Fifty ASAⅠ-Ⅱadult patients,with preoperative Lund-Mackay score 12,were randomly divided into two groups:TIVA group(n=25)and desflurane group(group D,n=25).The main outcome measure was intraoperative visibility as rated by surgeon utilizing numeric rating scale(NRS)and by the anesthesiologists with Beozaart scale,respectively.Secondary outcomes included operative blood loss,amount of fluids,intraoperative hemodynamic profile,and complications.Results Both surgeon and the anesthesiologist demonstrated a more favorable visual field with TIVA compared to desflurane(3.6 scores vs.5.2 scores,P<0.0001 with NRS by the surgeon;2.3 scores vs.3.2 scores,P<0.0001 with Beozaart scale by anesthesiologists).There was significantly less blood loss in the group TIVA compared to the group D[200(150,450)mL] vs.350(250,425)mL,P=0.00087.Less fluid was administrated in group D than that in group TIVA(1000(500,1000 mL)vs.1000(1000~1250)mL,P=0.00081).Regain of orientation and stay of post-anesthesia care unit were both shorter in TIVA group(P<0.05).Perioperative changes of mean artery pressure between the two groups were significantly different(P<0.0001),nor the heart rates.Conclusions TIVA contributes to improving intraoperative visualization,decreasing blood loss,and enhansing recovery in patients undergoing ESS for high-grade inflammatory sinus disease.

关 键 词：全凭静脉麻醉 慢性鼻窦炎 鼻内镜手术 手术视野 

分 类 号：R765.9[医药卫生—耳鼻咽喉科] R614[医药卫生—临床医学]