功能性内窥镜鼻窦手术中七氟醚或丙泊酚行控制性降压对局部脑氧饱和度的影响  

Effect of controlled hypotension with sevoflurane or propofol on cerebral oxygen saturation during functional endoscopic sinus surgery

作　　者：田元 孙乃会[1] 汤如荣[1] TIAN Yuan;SUN Naihui;TANG Rurong(Anesthesiology Department,The First Hospital of China Medical University,Shenyang 110001,China)

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医科大学学报》2023年第8期741-745,756,共6页Journal of China Medical University

基　　金：辽宁省科学技术计划(2022-MS-08)。

摘　　要：目的探讨功能性内窥镜鼻窦手术(FESS)中应用七氟醚或丙泊酚行控制性降压对患者局部脑氧饱和度(rSO_(2))的影响。方法将于我院择期行FESS的60例患者应用随机数表法分为2组,术中分别用七氟醚(S组,30例)和丙泊酚(P组,30例)行控制性降压,分别于入室时(T_(0))、麻醉诱导时(T_(1))、手术/控制性降压开始时(T_(2))、手术开始后10 min(T_(3))、手术开始后30 min(T_(4))、手术结束时(T_(5))、复压后10 min(T_(6))监测患者血流动力学(平均动脉压和心率)的变化和左右两侧区域rSO_(2),记录手术时间、出血量、术后不良反应发生情况及术野质量评分。结果在T_(3)~T_(5)时点,S组平均心率明显小于P组(P<0.05)。在T_(3)和T_(4)时点,P组左右两侧rSO_(2)与T_(0)时基线rSO_(2)的差值均明显高于S组,P组rSO_(2)下降更多(P<0.05)。2组比较,T4时点的术野评分无统计学差异(P>0.05)。结论与丙泊酚相比,FESS中应用七氟醚行控制性降压,能够在保证术野清晰的同时维持相对较高的rSO_(2),具有脑保护作用,且血流动力学更稳定。Objective To explore the effect of sevoflurane or propofol on regional cerebral oxygen saturation(rSO_(2))during functional endoscopic sinus surgery(FESS).Methods A total of 60 patients who were currently undergoing FESS at our hospital were randomly divided into two groups(n=30 per group).Patients underwent controlled hypotension with sevoflurane(group S)or propofol(group P)anesthesia.Hemodynamic changes,including mean arterial pressure(MAP),heart rate(HR),and bilateral rSO_(2),were monitored at the time of entry(T_(0)),induction of anesthesia(T_(1)),initiation of operation/controlled hypotension(T_(2)),10 min after operation(T_(3)),30 min after operation(T_(4)),conclusion of operation(T_(5)),and 10 min after blood pressure stabilization(T_(6)).The operation time,blood loss,postoperative adverse reactions,and field quality scores were recorded.Results From T_(3)to T_(5),the average HR of group S was significantly lower than that of group P(P<0.05).The difference between rSO_(2)on the left and right sides at T_(3)and T_(4)and the baseline rSO_(2)at T_(0)was significantly higher in group P than in group S,and the rSO_(2)in group P decreased more obviously(P<0.05).No significant difference in operative field scores at T_(4)were found between the two groups.Conclusion Compared with propofol,sevoflurane helps maintain higher cerebral oxygen saturation while ensuring a clear surgical field during controlled hypotension in FESS.In addition,the improved hemodynamic stability may have protective effects on the brain.

关 键 词：功能性内窥镜鼻窦手术 控制性降压 脑氧饱和度 七氟醚 丙泊酚 

分 类 号：R614.2[医药卫生—麻醉学]