Jacobi K E, Böhm B E, Rickauer A J, Jacobi C, Hemmerling T M
Department of Anesthesiology, University of Erlangen-Nuremberg, Erlangen, Germany.
J Clin Anesth. 2000 May;12(3):202-7. doi: 10.1016/s0952-8180(00)00145-8.
STUDY OBJECTIVES To determine if moderate controlled hypotension can improve the dryness of the surgical field in endoscopic sinus surgery.
Randomized, prospective study.
University-affiliated hospital.
32 ASA physical status I and II adult patients undergoing endoscopic sinus surgery.
All patients were premedicated orally with chlorazepate. Patients in Group H received 12.5 mg captopril orally prior to surgery. Anesthesia was provided using an intravenous (IV) technique supplemented with nitrous oxide (N(2)O); anesthesia was maintained with boluses of 2 mcg/kg fentanyl and a propofol infusion at rates between 3 and 9 mg/kg/h at the discretion of the anesthetist. In Group H, sodium nitroprusside was infused at a rate of 1 to 2.5 mcg/kg/min to maintain moderate controlled hypotension with mean blood pressure of 65 to 75 mm Hg.
Arterial blood pressure was assessed via the radial artery. Readings were recorded prior to intubation, immediately after intubation, at the start of surgery, then at 5, 15, 30, 45, and 60 minutes intraoperatively, and at the end of surgery. Intraoperative blood loss, dryness of the surgical field, adrenocorticotropic (ACTH) hormone, arginin-vasopressin (AVP), cortisol, and the preoperative and postoperative psychomotoric function were examined. At the start of surgery and thereafter, MAP increased in Group N but not in Group H. Throughout surgery, MAP was significantly lower in Group H than in Group N. Blood loss, dryness of the surgical field, ACTH, AVP, and cortisol levels, and psychomotoric function were not significantly different between the groups.
Intravenous anesthesia supplemented with N(2) is as effective as moderate controlled hypotension when blood loss, visibility in the surgical field, ACTH, AVP, and cortisol are examined.
研究目的 确定中度控制性低血压是否能改善鼻内镜手术术野的干燥程度。
随机前瞻性研究。
大学附属医院。
32例美国麻醉医师协会（ASA）身体状况为Ⅰ级和Ⅱ级的成年鼻内镜手术患者。
所有患者术前口服氯氮卓进行预处理。H组患者在手术前口服12.5毫克卡托普利。采用静脉（IV）技术并补充氧化亚氮（N₂O）进行麻醉；麻醉维持使用2微克/千克芬太尼推注以及由麻醉师酌情以3至9毫克/千克/小时的速率输注丙泊酚。在H组，以1至2.5微克/千克/分钟的速率输注硝普钠以维持中度控制性低血压，平均血压为65至75毫米汞柱。
通过桡动脉评估动脉血压。在插管前、插管后即刻、手术开始时、术中5、15、30、45和60分钟以及手术结束时记录读数。检查术中失血量、术野干燥程度、促肾上腺皮质激素（ACTH）、精氨酸加压素（AVP）、皮质醇以及术前和术后精神运动功能。在手术开始时及之后，N组的平均动脉压（MAP）升高，而H组未升高。在整个手术过程中，H组的MAP显著低于N组。两组之间的失血量、术野干燥程度、ACTH、AVP和皮质醇水平以及精神运动功能无显著差异。
在检查失血量、术野可视性、ACTH、AVP和皮质醇时，补充N₂的静脉麻醉与中度控制性低血压同样有效。
