步进式控制性低血压技术在视神经管微创减压手术的应用

发布时间：2018-06-13 02:24

本文选题：控制性低血压 + 鼻内镜　；参考：《中国内镜杂志》2014年10期

【摘要】：目的探讨如何减少实施控制性低血压对视神经管减压手术患者带来的不良影响。方法选择40例择期行视神经管减压手术的患者,随机分为A组(持续控制性低血压组)和B组(步进控制性低血压组),n=20。检测并计算手术开始时(T0)、切蝶窦前1 min(T1)、切开视神经鞘膜后1 min(T2)和送入术后恢复室后10 min(T3)的动脉-静脉乳酸含量差(Da-jvL),并进行鼻内镜术野质量评分(SESFQ)、手术时间(OT)及观察统计术后24 h内有肌肉酸痛和头痛等不良反应的患者人数。结果两组患者T1、T2和T3时点的Da-jvL较T0均有明显增加(P0.05),A组T1、T2和T3时点的Da-jvL明显高于B组(P0.05),B组T2时点的Da-jvL较T1和T3有明显增加(P0.01);B组T1和T2时点的SESFQ评分明显高于A组(P0.05),且B组T3时点的SESFQ评分明显低于T1和T2时点(P0.05);A组患者术后不良反应明显高于B组(P0.05)。结论步进式控制性低血压技术能有效改善围术期组织细胞不良代谢,降低不良事件的发生率,能提高视神经管减压手术患者的安全性。
[Abstract]:Objective to explore how to reduce the adverse effects of controlled hypotension on patients undergoing optic nerve tube decompression. Methods Forty patients undergoing selective optic canal decompression were randomly divided into two groups: group A (continuous hypotension group) and group B (stepwise controlled hypotension group). To detect and calculate the difference of arterial and venous lactic acid content at the beginning of operation, 1 minute before sphenoid sinus, 1 minute after incision of optic nerve sheath, 1 minute after incision of optic nerve sheath and 10 min after feeding into the recovery room after operation, and then perform nasal endoscopic surgery field quality score (SESFQs), time of operation (OT) and observation. The number of patients with adverse reactions such as muscle soreness and headache within 24 hours after operation were counted. Results compared with T0, Da-jvL of T1 T 2 and T 3 in both groups were significantly increased compared with T0. The scores of Da-jvL at T 1 T 2 and T 3 in group A were significantly higher than those at T 2 in group B and group B, and the SESFQ scores at T 1 and T 2 in group B were significantly higher than those in group A. The score of SESFQ at T3 in group B was significantly lower than that in group A at T1 and T2, and the adverse reaction in group A was significantly higher than that in group B (P 0.05). Conclusion the stepwise controlled hypotension technique can effectively improve perioperative tissue and cell adverse metabolism, reduce the incidence of adverse events, and improve the safety of optic canal decompression.
【作者单位】：温州医科大学附属眼视光医院;
【分类号】：R779.6

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