鼻内镜手术206例的全麻处理
【关键词】 鼻内镜术 ；全身麻醉 ；控制性降压
General anesthesia deal with 206 cases endoscopic sinus surgery
【Abstract】 Objective To discuss the advantages and management of general anesthesia (GA) with endotracheal tube(ETT) in endoscopic sinus surgery(ESS); Method 206 patients underwent the procedure of endoscopic sinus surgery with GA & ETT for deviated nasal septum, rhinopolypus， sinusitis or its recurrence.Those who were bleeding seriously intraoperative accompanied with controlled hypotension. Results The collaboration of these patients under GA & ETT is enoungh for the surgical procedure. Meanwhile, the intraoprative blood loss is reduced obviousely along with controlled hypotension. Conclusion The GA & ETT is an ideal anesthesiologic method for ESS. Its advantages include good analgesia and a bloodless surgical field for précised surgical procedure. However, the management of GA in the ESS is different from other operation because the operation district is near the airway.
【Key words】endoscopic sinus surgery;general anesthesia;controlled hypotension
我国鼻窦内镜手术是20世纪80年代发展起来的鼻窦微创手术，目前已成为治疗慢性鼻窦炎与鼻息肉的首选方法，以其手术视野好、手术精细程度高、手术彻底而受到良好的治疗效果。以往手术大多数都采用局部麻醉，我院自开展此手术以来，根据病情及手术情况选择实施全身麻醉+气管内插管，或辅以控制性降压的麻醉方法，现总结206例报告如下。
1 资料与方法
1.1 一般资料
本组206例ASAⅠ～Ⅲ级患者，因鼻息肉及副鼻窦炎等接受手术治疗，男126例，女80例，年龄16～75岁，平均41.2岁，体重34～87kg。其中合并高血压患者17例，糖尿病5例，冠心病史者12例。手术种类包括：鼻中隔偏曲、单侧或双侧鼻窦炎、鼻息肉以及手术后复发再次手术等，手术时间1/2～4h。
1.2 麻醉方法
术前肌注阿托品0.5mg,鲁米那钠0.1g。入室后开放静脉，术中用Spacelabs105+监护仪监测血压、脉率、呼吸、心电、血氧饱和度及PetCO2 。麻醉诱导：咪唑安定0.1mg/kg，芬太尼5～6μg/kg，维库溴铵0.1mg/kg，异丙酚2mg/kg。静注后快速诱导气管内插管。使用Drager GS麻醉机控制呼吸，全麻维持用芬太尼、维库溴铵单次静脉注射，根据麻醉深浅辅助异丙酚静脉注射或安氟醚/异氟醚吸入，手术结束后常规用新斯的明拮抗肌松药。
2 结果
2.1 麻醉结果
术中患者处于全麻状态中，顺利配合手术进行，25例因手术中手术创面渗血较多使用硝普钠进行控制性降压，手术失血量在50～1200ml之间。术毕患者苏醒按照全麻苏醒拔管的标准拔除气管导管。
