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

Application of stepping controlled hypotension in minimally invasive optic nerve decompression surgery

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（P <0.05），A组T1、T2和T3时点的Da-jvL明显高于B组（P <0.05），B组T2时点的Da-jvL较T1和T3有明显增加（P <0.01）；B组T1和T2时点的SESFQ评分明显高于A组（P <0.05），且B组T3时点的SESFQ评分明显低于T1和T2时点（P <0.05）；A组患者术后不良反应明显高于B组（P <0.05）。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 investigate the method of reducing adverse effects of controlled hypotension on the optic nerve decompression surgery. 【Methods】 40 cases with optic nerve decompression surgery were randomly divided into group A (continued controlled hypotension), group B (stepping controlled hypotension), n =20. The lactate content difference in Arterial-venous (Da-jvL) at the start of surgery (T0) were detected and calculated,1min before cut sphenoid (T1), after opticed nerve sheath incision 1 min (T2),after going into the recovery room 10 min (T3);The scores of endoscopic surgical field quality (SESFQ) were recorded at T1,T2,T3. Operation time (OT) and number of cases with muscle aches or headaches within postoperative 24 hours were recorded. 【Results】 Da-jvL of two group at T1,T2,T3 were higher than which of T0 (P ＜0.05). Da-jvL of group A at T1,T2,T3 were higher than which of group B (P ＜0.05). and Da-jvL of group B at T2were higher than which at T1,T3 (P ＜0.01); SESFQ of group B at T1,T2 were higher than group A (P ＜0.05). and SESFQ of group B at T3 was lower than which at T1,T2 (P ＜0.05); Number of cases with postoperative adverse reactions of group A were higher than that of group B (P ＜0.05). 【Conclusion】 Stepping controlled hypotension can effectively improve poor metabolism of tissues and cells within perioperative,and reduce the incidence of adverse events, and increase patients safety with optic nerve decompression surgery.