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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。
Objective To compare the effects of sevoflurane and propofol on bleeding during endoscopic sinus surgery. Methods Thirty patients with ASA Ⅰ or Ⅱ undergoing elective endoscopic sinus surgery under the age of 18-65 years were included in this study. The preoperative CT Lund-Mackay score was> 12 and were randomly divided into sevoflurane group (group S) and propofol Group (Group P) (n = 15). The patients were anesthetized with sevoflurane anesthesia by intra-tracheal static inhalation combined with continuous infusion of remifentanil 0.1μg / (kg · min) intra-operatively. Patients in group P received intravenous infusion of propofol Phenol to maintain anesthesia, intraoperative by increasing inhalation or infusion concentration to deepen anesthesia, blood pressure control at 75% of the base pressure. The intraoperative bispectral index (BIS) was monitored. The patients’ preoperative hemoglobin content and hemoglobin content in the aspiration flask were measured respectively to calculate the blood loss. The surgeon was asked to evaluate the intraoperative blood loss using the VAS method. Results The BIS values of S group and P group were (44 ± 6) and (36 ± 7), P group was significantly lower than that of S group (P <0.05), blood loss of S group and P group were (148.9 ± 30) ml and (119.4 ± 20) ml, P group was significantly less than the S group (P <0.05), but the subjective assessment of blood loss VAS was no significant difference (P> 0.05). Conclusions In endoscopic sinus surgery, propofol is effective in reducing intraoperative blood loss when sevoflurane or propofol is used to maintain anesthesia.