比较七氟醚和丙泊酚对于内镜鼻窦手术术中出血的影响

目的比较七氟醚和丙泊酚对于内镜鼻窦手术术中出血的影响。方法择期行内镜鼻窦手术的患者30例,ASAⅠ或Ⅱ级,年龄18～65岁,术前CT Lund-Mackay评分〉12分,随机分为,七氟醚组（S组）和丙泊酚组（P组）（n=15）。采用气管内静吸复合全身麻醉,术中持续输注雷米芬太尼0.1μg/（kg·min）,S组术中使用七氟醚吸入维持麻醉,P组使用血浆靶控输注丙泊酚维持麻醉,术中通过分别提高吸入或输注浓度加深麻醉,控制血压于在75%的基础压。术中监测脑双频指数（bispectral index,BIS）,分别测定患者术前的血红蛋白含量和吸引瓶中的血红蛋白含量计算失血量,并请手术医生使用VAS方法评估术中失血量。结果术中S组和P组BIS值分别为（44±6）和（36±7）,P组明显低于S组（P〈0.05）,S组和P组的失血量分别为（148.9±30）ml和（119.4±20）ml,P组明显少于S组（P〈0.05）,但失血量VAS主观评估的差异无统计学意义（P〉0.05）。结论在内镜鼻窦手术中,使用七氟醚或丙泊酚维持麻醉时,丙泊酚可有效减少术中失血。

Comparison of sevoflurane and propofol anesthesia on blood loss during endoscopic sinus surgery

Objective To evaluate blood loss under general anesthesia maintained with sevoflurane inhalation or propofol plasma target controlled infusion during endoscopic sinus surgery. Methods 30 patients undergoing endoscopic sinus surgery with ASA I-II and aged from 28-65 years were randomly assigned to group S （ n =15） or group P （ n =15）. After induction,anesthesia were maintained with sevoflurane inhalation in group S or with propofol plasma target controlled infusion in group P,both combined with remifentanil 0. 1μg/（ kg· min）. The mean arterial blood pressure were adjusted to 25 percent below baseline by increasing sevoflurane inhalation concentration or increasing propofol target infusion concentration. Bispectral index （ BIS） was monitoring during procedures. The amount of intraoperative blood loss was calculated from the patients＇haemoglobin （ Hb） and the amount of blood in the suction canister. The surgeons rated blood loss by VAS at the ends of pro-cedure. Results The mean BIS during procedures in group S and group P was （ 44 ± 6） and（ 36 ± 7） ,respectively （ P 0. 05）. The mean blood loss for group S and group P was （ 148. 9 ± 30） and （ 119. 4 ± 20） ml,respectively,but no significant difference of blood loss was found in VAS rated by surgeon （ P 0. 05）. Conclusion During endoscopic sinus surgery,propofol anesthesia results in less blood loss than sevoflurane anesthe-sia.