中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2014年
4期
385-388
,共4页
心率%降压,控制性%鼻黏膜
心率%降壓,控製性%鼻黏膜
심솔%강압,공제성%비점막
Heart rate%Hypotension,controlled%Nasal mucosa
目的 评价控制心率(HR)对鼻内镜手术患者硝酸甘油控制性降压时鼻粘膜血流的影响.方法 择期拟行鼻内镜手术患者72例,ASA分级Ⅰ或Ⅱ级,年龄18～45岁,体重49 ～ 85 kg,BMI＜ 30 kg/m2,性别不限,Lund-Mackay评分7-15分,采用随机数字表法分为2组(n=36):硝酸甘油组(N组)和硝酸甘油控制性降压复合艾司洛尔组(E组).手术开始前静脉输注硝酸甘油1～3μg·kg-1·min-1行控制性降压,维持MAP为基础值的70％至术毕.E组待MAP降至基础值70％时,静脉输注艾司洛尔20～ 100 μg·kg-1·min-1,根据HR调节用量,维持HR 60 ～ 70次/min至降压结束.于麻醉诱导前(T0)、鼻腔表面麻醉后(T1)、控制性降压15 min(T2)、30min(T3)、45 min(T4)、术毕填塞止血(T5)时记录HR、SV、CO,T1-T4时测定鼻粘膜血流量,同步采集桡动脉血样和颈内静脉球部血样,进行血气分析,计算动静脉血氧含量差(Da-jvO2)、脑氧摄取率(CER02).采用术野质量评分法评定术野出血量.结果 与N组比较,E组T2-T5时HR、SV和CO、T2-T4时鼻粘膜血流量降低,术野出血量降低(P＜0.01),Da-jvO2和CERO2差异无统计学意义(P＞0.05).结论 控制HR(60 ～ 70次/min)可减少鼻内镜手术患者硝酸甘油控制性降压时鼻粘膜血流,且未引起组织灌注不足.
目的 評價控製心率(HR)對鼻內鏡手術患者硝痠甘油控製性降壓時鼻粘膜血流的影響.方法 擇期擬行鼻內鏡手術患者72例,ASA分級Ⅰ或Ⅱ級,年齡18～45歲,體重49 ～ 85 kg,BMI＜ 30 kg/m2,性彆不限,Lund-Mackay評分7-15分,採用隨機數字錶法分為2組(n=36):硝痠甘油組(N組)和硝痠甘油控製性降壓複閤艾司洛爾組(E組).手術開始前靜脈輸註硝痠甘油1～3μg·kg-1·min-1行控製性降壓,維持MAP為基礎值的70％至術畢.E組待MAP降至基礎值70％時,靜脈輸註艾司洛爾20～ 100 μg·kg-1·min-1,根據HR調節用量,維持HR 60 ～ 70次/min至降壓結束.于痳醉誘導前(T0)、鼻腔錶麵痳醉後(T1)、控製性降壓15 min(T2)、30min(T3)、45 min(T4)、術畢填塞止血(T5)時記錄HR、SV、CO,T1-T4時測定鼻粘膜血流量,同步採集橈動脈血樣和頸內靜脈毬部血樣,進行血氣分析,計算動靜脈血氧含量差(Da-jvO2)、腦氧攝取率(CER02).採用術野質量評分法評定術野齣血量.結果 與N組比較,E組T2-T5時HR、SV和CO、T2-T4時鼻粘膜血流量降低,術野齣血量降低(P＜0.01),Da-jvO2和CERO2差異無統計學意義(P＞0.05).結論 控製HR(60 ～ 70次/min)可減少鼻內鏡手術患者硝痠甘油控製性降壓時鼻粘膜血流,且未引起組織灌註不足.
목적 평개공제심솔(HR)대비내경수술환자초산감유공제성강압시비점막혈류적영향.방법 택기의행비내경수술환자72례,ASA분급Ⅰ혹Ⅱ급,년령18～45세,체중49 ～ 85 kg,BMI＜ 30 kg/m2,성별불한,Lund-Mackay평분7-15분,채용수궤수자표법분위2조(n=36):초산감유조(N조)화초산감유공제성강압복합애사락이조(E조).수술개시전정맥수주초산감유1～3μg·kg-1·min-1행공제성강압,유지MAP위기출치적70％지술필.E조대MAP강지기출치70％시,정맥수주애사락이20～ 100 μg·kg-1·min-1,근거HR조절용량,유지HR 60 ～ 70차/min지강압결속.우마취유도전(T0)、비강표면마취후(T1)、공제성강압15 min(T2)、30min(T3)、45 min(T4)、술필전새지혈(T5)시기록HR、SV、CO,T1-T4시측정비점막혈류량,동보채집뇨동맥혈양화경내정맥구부혈양,진행혈기분석,계산동정맥혈양함량차(Da-jvO2)、뇌양섭취솔(CER02).채용술야질량평분법평정술야출혈량.결과 여N조비교,E조T2-T5시HR、SV화CO、T2-T4시비점막혈류량강저,술야출혈량강저(P＜0.01),Da-jvO2화CERO2차이무통계학의의(P＞0.05).결론 공제HR(60 ～ 70차/min)가감소비내경수술환자초산감유공제성강압시비점막혈류,차미인기조직관주불족.
Objective To evaluate the effects of controlled heart rate (HR) on the nasal mucosa blood flow (NMBF) during nitroglycerin (NTG)-induced controlled hypotension in the patients undergoing endoscopic sinus surgery.Methods Seventy-two ASA physical status Ⅰ or Ⅱ patients of both sexes,weighing 49-85 kg,with body mass index ＜ 30 kg/m2 and Lund-Mackay score between 7 and 15,scheduled for elective endoscopic sinus surgery,were randomly divided into 2 groups (n =36 each) using a random number table:NTG group (group N) and NTG-induced controlled hypotension combined with esmolol group (group E).Controlled hypotension was induced with continuous iv infusion of NTG at 1-3 μg· kg-1 · min-1 before surgery,and MAP was maintained at 70％ of baseline value until the end of surgery.In group E,when MAP was decreased to 70％ of baseline value,esmolol was infused intravenously at 20-100 μg· kg-1 · min-1,the consumption was adjusted according to the HR,and the HR was maintained at 60-70 beats/min until termination of controlled hypotension.Before induction of anesthesia (T0),after topical anesthesia (T1),at 15,30 and 45 min of controlled hypotention (T2-4),and at packing hemostasis at the end of surgery (T5),HR,stroke volume (SV) and cardiac output (CO) were recorded.NMBF was monitored at T1-T4.Blood samples were drawn from the radial artery and jugular blub at T1-T5 for blood gas analysis.Arteriovenous blood O2 difference (Da-jvO2) and cerebral O2 extraction rate (CERO2) were calculated.The quality of the surgical field in terms of blood loss was rated by the same attending surgeon.Results Compared with group N,HR,SV and CO at T2-T5,NMBF at T2-T4 and the volume of blood loss in the surgical field was significantly decreased in group E (P ＜ 0.01).There was no significant difference in Da-jvO2 and CERO2 between the two groups (P ＞ 0.05).Conclusion Controlled HR (60-70 beats/min) can reduce the NMBF during nitroglycerin-induced controlled hypotension in the patients undergoing endoscopic sinus surgery without causing tissue hypoperfusion.
