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目的探讨静吸复合麻醉下用硝酸甘油控制性降压用于鼻内窥镜手术的可行性和安全性。方法选择鼻内窥镜直视下治疗鼻窦炎及鼻息肉患者50例,按随机数字表法分为两组:降压组25例,先行静吸复合全麻后用硝酸甘油[1~10μg/(kg.m in)]控制降压;对照组25例,为单纯静吸复合全麻组。比较两组术中出血量、手术时间、输液量、血压(BP)、心率(HR)、尿量、输血量。结果在静吸复合全麻后用硝酸甘油控制降压,术中血压较对照组显著降低(P<0.01),降压组均实现控制性降压。降压组出血量比对照组显著减少(P<0.01),手术时间明显缩短(P<0.01),输液量和尿量较对照组减少(P<0.01),无任何并发症。两组术中HR差异无统计学意义(P>0.05)。结论静吸复合麻醉下用硝酸甘油控制降压,用于鼻内窥镜手术是安全可行的,可减少术中出血、缩短手术时间。
Objective To investigate the feasibility and safety of controlled hypotension with nitroglycerin under nasal inhalation anesthesia for nasal endoscopic surgery. Methods Fifty patients with sinusitis and nasal polyps under nasal endoscope were randomly divided into two groups according to random number table: 25 cases were treated with antihypertensive drugs, followed by intravenous anesthesia with nitroglycerin [1 ~ 10μg / (kg.m in)] controlled hypotension; control group of 25 cases, simple static suction combined with general anesthesia group. Blood loss, operation time, infusion volume, blood pressure (BP), heart rate (HR), urine output and blood transfusion volume were compared between the two groups. Results After intravenous anesthesia combined with nitroglycerin, the blood pressure was lower than that of the control group (P <0.01). Both of the two groups achieved controlled hypotension. The blood loss of the blood pressure-reducing group was significantly lower than that of the control group (P <0.01), the operation time was shortened (P <0.01), and the amount of transfusion and urine output were decreased compared with the control group (P <0.01). There was no significant difference in HR between two groups (P> 0.05). Conclusion Under the combination of static inhalation and nitroglycerin, the blood pressure is controlled by nitroglycerin, which is safe and feasible for endoscopic sinus surgery. It can reduce intraoperative bleeding and shorten the operation time.