异氟醚用于鼻内窥镜术控制性降压临床研究

目的:观察异氟醚用于鼻内窥镜术患者控制性降压时的疗效,探讨异氟醚控制性降压的机理。方法:选择200例ASAⅠ～Ⅱ级择期行鼻内窥镜手术患者,手术初期用硝酸甘油1μg.kg-1.min-1,逐渐加快输注速率,控制平均动脉压(MAP)55～65mmHg,当心率>100次/min时,静注艾司洛尔,使心率控制在90次/min以下,随后逐渐升高吸入异氟醚浓度到1.5%～2.0%,降低硝酸甘油的输注速率,直至停用硝酸甘油和艾司洛尔,测定麻醉前、停用硝酸甘油和艾司洛尔10、30min及呼气末异氟醚不同浓度时压力感受反射敏感性(BRS)。结果:当呼气末异氟醚浓度达到1.5%后(30±15)min停用硝酸甘油和艾司洛尔。随着异氟醚呼气末浓度的增加,BRS逐渐降低,不同时间点间BRS差异有统计学意义(P<0.05～0.01)。结论:异氟醚达到一定麻醉深度或抑制BRS,用于鼻内窥镜术控制性降压效果较好。

Effects of controlled hypotension with isoflurane anaesthesia during endoscopic sinus surgery

Objective： To investigate the effects of controlled hypotension with isoflurane anaesthesia during endoscopic sinus surgery and its mechanism. Methods： A total of 200 ASA Ⅰ～Ⅱ patients that were scheduled for endoscopic sinus surgery were enrolled in this study. At the early stage, nitroglycerin 1μg·kg^-1·min^-1 was injected at an increased speed until the mean arterial pressure （MAP） was 55-65 mmHg, when the heart beat was more than 100 times/rain, intravenous esmolol was given to control it under 90 times/min, then concentration of the inhaled isoflurane was increased to be 1.5 %- 2.0%, meanwhile, rate of nitroglycerin infusion was reduced. Stress reflex sensitivity （BRS） was measured 10 and 30 minutes after the withdrawal of nitroglycerin and esmolol, as well as under different concentration of isoflurane （encl tidal value）. Results： When the encl tidal isofluranc concentration was 1.5%, （30 ± 15） min, the infusion of esmolol and nitroglycerin was withdrawaled. BRS decreased with the end-tidal isoflurane concentration with significant difference between different time points （P〈0.05 or 0. 01）. Collusions： When deep anesthesia is induced by isoflurane or BRS is depressed, well controlled hypoten sion can be achieved for endoscopic sinus surgery.