鼻内窥镜手术自主呼吸恢复并保留对控制性降压效果的影响  

Effect of spontaneous respiratory recovery and retention in endoscopic nasal surgery on controlled hypotension

作　　者：刘超[1] 唐妮娜 赵亚娟[1] 孙玉琦[1] 熊璐 Liu Chao;Tang Nina;Zhao Yajuan;Sun Yuqi;Xiong Lu(Department of Anesthesiology,Guangzhou Twelfth People′s Hospital(Guangzhou Otolaryngology-Head and Neck Surgery Hospital),Guangdong 510620,China)

机构地区：[1]广东省广州市第十二人民医院(广州市耳鼻咽喉头颈外科医院)麻醉科,510620

出　　处：《山西医药杂志》2022年第23期2672-2675,共4页Shanxi Medical Journal

摘　　要：目的探讨全身麻醉气管插管下鼻内窥镜手术自主呼吸恢复并保留对控制性降压效果的影响及可行性分析。方法分析我院全身麻醉气管插管下成人鼻内窥镜全组鼻窦开放术手术计43例,全部患者麻醉诱导单次使用顺阿曲库铵,术中不再追加肌肉松弛剂。根据患者术中自主呼吸是否恢复,将患者分成A组(自主呼吸恢复并保留组,17例)和C组(机械通气组,26例)。应用丙泊酚、瑞芬太尼维持麻醉深度,保持脑电图双频指数(BIS)50±5。全部患者静脉泵入硝酸甘油,实施控制性降压维持有创平均动脉压(MAP)50~70mmHg,降压幅度不超过术前MAP的30%。记录患者一般资料,手术操作时间、术毕至拔管时间,术中使用丙泊酚、瑞芬太尼、硝酸甘油量,气道压力监测参数及拔管后1 min、10 min、20 min的血氧饱和度(SPO_(2)),A组自主呼吸恢复后1 min、10 min、20 min呼气末二氧化碳分压(PetCO_(2))。结果2组患者术毕至拔管时间差异有统计学意义(P=0.023)。A组患者拔管前气道峰压(Ppeak)、气道平台压(Pplat)均较C组明显降低(P<0.001)。2组患者两时点间Ppeak、Pplat均差异有统计学意义(P<0.001)。拔管后1 min、10 min SPO_(2)比较显示A组高于C组;2组内3个时点间SPO_(2)差异有统计学意义,拔管后SPO_(2)随时间延长而增长。A组自主呼吸恢复后1 min、10min、20 min PetCO_(2)下降并保持生理参数范围内。结论全身麻醉气管插管下鼻内窥镜手术自主呼吸恢复并保留对控制性降压效果无明显影响,术后快速气管拔管,并维持良好的自主呼吸,该方法可供临床工作参考。Objective To evaluate the effect of spontaneous respiratory recovery and retention in endoscopic nasal surgery on controlled hypotension.Methods Forty-three patients with chronic sinusitis undergoing nasal endoscopy by general anesthesia were enrolled in this medical observation.They were divided into two groups.A group(spontaneous respiration recover and keep during the operation,17 cases)and C group(no spontaneous respiration,26 cases).After anesthesia induction and intubation,no muscle relaxant was given anymore.Propofol and remifentanil were injected continuously to keep BIS 50±5.All patients were injected in nitroglycerin to control hypotension.The patients′general conditions,time of operation,duration from the end of operation to extubation,consumption of propofol and remifentanil,and nitroglycerine,the parameters of airway,SPO_(2),PetCO_(2)and so on were all recorded.Results Duration from the end of the operation to extubation was significantly different between the two groups(P=0.023).Ppeak and Pplat of A group were lower than C group at the time point of pre-extubation(P<0.001).Ppeak and Pplat were significantly different of both groups between the two time points(P<0.001).SPO_(2)of A group was higher than C group at the time point of 1min and 10 min after extubation.SPO_(2)would get higher after extubation as it went by.PetCO_(2)would get lower and be kept well in the physiological range.Conclusion Spontaneous respiration seems to have nothing to control hypotension undergoing nasal endoscopy by general anesthesia,extubation can be conducted soon after the operation.This method may be tried during clinical work.

关 键 词：慢性鼻窦炎 鼻内窥镜技术 控制性降压 全身麻醉 自主呼吸 

分 类 号：R614[医药卫生—麻醉学]