摘要： 目的 探讨功能性内窥镜鼻窦手术（FESS）中应用七氟醚或丙泊酚行控制性降压对患者局部脑氧饱和度（rSO₂）的影响。方法 将于我院择期行FESS的60例患者应用随机数表法分为2组，术中分别用七氟醚（S组，30例）和丙泊酚（P组，30例）行控制性降压，分别于入室时（T₀）、麻醉诱导时（T₁）、手术/控制性降压开始时（T₂）、手术开始后10 min （T₃）、手术开始后30 min （T₄）、手术结束时（T₅）、复压后10 min （T₆）监测患者血流动力学（平均动脉压和心率）的变化和左右两侧区域rSO₂，记录手术时间、出血量、术后不良反应发生情况及术野质量评分。结果 在T₃~T₅时点，S组平均心率明显小于P组（P<0.05）。在T₃和T₄时点，P组左右两侧rSO₂与T₀时基线rSO₂的差值均明显高于S组，P组rSO₂下降更多（P<0.05）。2组比较，T₄时点的术野评分无统计学差异（P>0.05）。结论 与丙泊酚相比，FESS中应用七氟醚行控制性降压，能够在保证术野清晰的同时维持相对较高的rSO₂，具有脑保护作用，且血流动力学更稳定。

功能性内窥镜鼻窦手术中七氟醚或丙泊酚行控制性降压对局部脑氧饱和度的影响

田元, 孙乃会, 汤如荣

中国医科大学附属第一医院麻醉科, 沈阳 110001

收稿日期:2023-03-28出版日期:2023-08-30发布日期:2023-08-07
通讯作者:汤如荣E-mail:rrtang@cmu.edu.cn
作者简介:田元(1993-),女,医师,硕士.
基金资助:辽宁省科学技术计划（2022-MS-08）


关键词: 功能性内窥镜鼻窦手术, 控制性降压, 脑氧饱和度, 七氟醚, 丙泊酚
Abstract: Objective To explore the effect of sevoflurane or propofol on regional cerebral oxygen saturation (rSO₂) during functional endoscopic sinus surgery (FESS). Methods A total of 60 patients who were currently undergoing FESS at our hospital were randomly divided into two groups (n=30 per group). Patients underwent controlled hypotension with sevoflurane (group S) or propofol (group P) anesthesia. Hemodynamic changes,including mean arterial pressure (MAP),heart rate (HR),and bilateral rSO₂,were monitored at the time of entry (T₀),induction of anesthesia (T₁),initiation of operation/controlled hypotension (T₂),10 min after operation (T₃),30 min after operation (T₄),conclusion of operation (T₅),and 10 min after blood pressure stabilization (T₆). The operation time,blood loss,postoperative adverse reactions,and field quality scores were recorded. Results From T₃ to T₅,the average HR of group S was significantly lower than that of group P (P < 0.05). The difference between rSO₂ on the left and right sides at T₃ and T₄ and the baseline rSO₂ at T₀ was significantly higher in group P than in group S,and the rSO₂ in group P decreased more obviously (P < 0.05). No significant difference in operative field scores at T₄ were found between the two groups. Conclusion Compared with propofol,sevoflurane helps maintain higher cerebral oxygen saturation while ensuring a clear surgical field during controlled hypotension in FESS. In addition,the improved hemodynamic stability may have protective effects on the brain.
Key words: functional endoscopic sinus surgery, controlled hypotension, cerebral oxygen saturation, sevoflurane, propofol
PDF全文下载地址:

https://journal.cmu.edu.cn/CN/article/downloadArticleFile.do?attachType=PDF&id=3270