悬雍垂腭咽成形术中控制性降压的应用研究_医学论文.docVIP

悬雍垂腭咽成形术中控制性降压的应用研究_医学论文 悬雍垂腭咽成形术中控制性降压的应用研究_医学论文 作者：汪晨　张英民　刘慧芬　熊东方　李扬　路志红 【关键词】 低血压 关键词: 悬雍垂/外科学腭/外科学咽/外科学睡眠呼吸暂停综合征低血压，控制血压 摘 要:目的 探讨控制性降压应用于悬雍垂腭咽成形术（UPPP）中的意义. 方法 100例阻塞性睡眠呼吸暂停综合征（OSAS）患者随机分为两组，对照组采用静吸复合全麻，降压组（IH）采用控制性降压全麻. 结果 血液稀释下，IH组术中平均动脉压（MAP）、心率（HR）均较对照组明显降低（0.05or 0.01），而对照组术中MAP，HR维持在高水平，且波动幅度较大IH组术野出血量较对照组显著减少（0.01），手术时间明显缩短（0.05）IH组术野清晰度提高，方便术者操作，减轻手术创伤. 结论 初步认为:控制性降压应用于UPPP手术中安全、有效. 　　Keywords:uvula/surgerypalate/surgerypharynx/surgerysleep apnea syndromeshypotension，controlledblood pressure 　　Abstract:AIM To appreciate the meaning of induced hy-potension（IH）being used undergoing uvulopalato-pharyngo-plasty（UPPP）.METHODS One hundred patients of ob-structive sleep apnea syndrome（OSAS）were randomly divid-ed into two groups（ControlampIH）.Introvenous-inhalational complexed anesthesia was used in Control and induced　hypotensive general anesthesia was used in IH.RESULTS Under the condition of haemodilution，the introperative mean arterial pressure（MAP）and heart rate（HR）in IH were sig-nificantly lower than those in control（0.05or 0.01）.However，the introperative MAP and HR in control were maintained at high level，whcih fluctuated greatly.Blood loss in operative scope in IH was significantly reduced and much less than those in Control（0.01）.Operation time in IH was shortened considerably（0.05）.Operative view clari-ty in IH was much better than those in Control，which made it convenient for surgeons to perform operation and reduce operative trauma.CONCLUSION Our study preliminarily shows that induced hypotension is safe and effective to be used in UPPP. 　　0 引言 　　严重鼾症可导致阻塞性睡眠呼吸暂停综合症（obstructive sleep apnea syndrome，OSAS）的发生，近年国内该类患者要求行悬雍垂腭咽成形术（uvu-lopalatopharyngoplasty，UPPP）的人数呈上升趋势.因OSAS患者咽腔狭小、术野显露差、血运丰富、出血多，损伤大，术中、术后并发症较多，严重的围手术期并发症可致患者死亡，故UPPP手术麻醉安全性差.如何减少术中出血，方便术者操作，防止术中、术后并发症发生，提高术中麻醉的安全性是急待研究解决的问题.近期我们将控制性降压（Induced hy-potension，IH）引入UPPP术中，现将观察结果报道如下. 　　1 对象和方法 　　1.1 对象 100例OSAS患者随机分为对照组（Control）、控制性降压组（IH），每组各50例，两组患者均为成年男性，IH组年龄28～51