| Objective:Operative field bleeding is the most difficult problem in endoscopic sinus surgery,and a good surgical field is the key to success.Controlled hypotension is one of the means to improve the quality of operative field by reducing operative bleeding.As an agonist of vasopressin VZ receptor,desmopressin can relax blood vessels and improve coagulation.The effects of desmopressin,sodium nitroprusside and esmolol on bleeding and hemodynamics in functional endoscopic sinus surgery were studied.The correlation between surgical field score and mean arterial pressure(MAP)and heart rate(HR)was analyzed.Methods:Seventy-five ASA Ⅰ～Ⅱ patients undergoing unilateral functional endoscopic sinus surgery under general anesthesia were randomly divided into three groups:group D(desmopressin group),group N(sodium nitroprusside group)and group E(esmolol group),with 25 cases in each group.After anesthesia induction,group D was injected with desmopressin 0.3μg/kg intravenously for 60 min.The N group was given intravenous injection of sodium nitroprusside at an initial infusion rate of 0.2μg/(kg · min).Esmolol(Group E)was initially administered by a bolus of 500μg/(kg · min)over one minute,and then maintained at 50 μg/(kg·min)to 200μg/(kg · min).According to the operation field,the infusion rate of sodium nitroprusside and esmolol was adjusted so that the mean arternal pressure(MAP)decreased step by step at 5 mmHg.The operation was performed by the same surgeon and was blind to the drugs and hemodynamic parameters used.The quality of the operative field was evaluated by the surgeon according to the Fromme score scale(0～5)per 10 min,and 2～3 points were the ideal.More than 3 points in group D were supplemented with remifentanil,which could be added repeatedly.The quality score of operative field,heart rate(HR),invasive blood pressure,end-expiratory carbon dioxide partial pressure(PetCO2)per 5 min from admission to the end of operation were recorded.Operation time,extubation time and the dosage of propofol,remifentanml,dopamine and atropine were recorded.Results:1.Satisfactory operative field quality can be achieved in all the three groups,but ideal operative conditions can be achieved in group D and group E with mild hypotension(MAP>70 mmHg),while the same conditions can only be created in group N with MAP within 65～69 mmHg.When the MAP was lower than 65 nmHg,there was no statistically significant difference in the quality of the operative field between the three groups.2.MAP decreased in all the three groups after treatment,with the maximum decrease being 21%,32%and 26%of the basic values,respectively.HR and PetCO2 increased in group D.HR and PetCO2 did not change significantly in group N.HR decreased the most and PetCO2 decreased slightly in group E.3.The correlation analysis between the quality of operative field and MAP and HR:the quality of operative field in group D and E was positively correlated with MAP and HR.The quality of operative field in group N was only positively eon.elated with MAP.The correlation between the quality of operative field and MAP in group N was higher than that in group E and higher than that in group D,and the correlation coefficients r were 0.540,0.388 and 0.261,respectively.The correlation between the quality of operative field and HR group E was higher than group D,and the correlation coefficients r were 0.328 and 0.261,respectively.4.There was no significant difference in operation time,extubation time and the dosage of propofol,remifentanil,dopamine and atropine among the three groups.Conclusion:Compared with sodium nitroprusside,desmopressin and esmolol can provide a better operative condition for functional endoscopic sinus surgery.Desmopressin may be more beneficial to the patients with a mild decrease in blood pressure and stable cardiac output and improved coagulation. |
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