2025 年第 7 期 第 20 卷

丙泊酚复合氧化亚氮静脉吸入复合麻醉在老年患者行鼻内镜手术中的应用效果和安全性

Application effect and safety of intravenous inhalation of propofol and nitrous oxide combined anesthesia in elderly patients undergoing endoscopic sinus surgery

作者：李琼杨文婧王古岩

英文作者：Li Qiong Yang Wenjing Wang Guyan

单位：首都医科大学附属北京同仁医院麻醉科，北京100730

英文单位：Department of Anaesthesiology Beijing Tongren Hospital Capital Medical University Beijing 100730 China

关键词：鼻内镜手术；氧化亚氮；丙泊酚

英文关键词：Endoscopicsinussurgery;Nitrousoxide;Propofol

• 摘要：

• 目的 探讨丙泊酚复合氧化亚氮静脉吸入复合麻醉在老年患者行鼻内镜手术中的应用效果和安全性。方法 选取2022年2月至2023年9月首都医科大学附属北京同仁医院收治的择期行全身麻醉下鼻内镜手术的老年患者60例，根据随机数字表法分为全静脉麻醉（TIVA）组和氧化亚氮组，每组30例，2组均进行静脉诱导喉罩全身麻醉，TIVA组术中丙泊酚和瑞芬太尼维持麻醉，氧化亚氮组术中丙泊酚、瑞芬太尼复合氧化亚氮吸入维持麻醉，术毕患者均自然苏醒。记录术后苏醒时间、麻醉后监测治疗室(PACU)停留时间和最低血氧饱和度数值；记录术中血流动力学变化和血管活性药物使用率；记录术中出血的Boezaart分级量表（BS）得分、术中出血量、出血速度；记录术后不良反应的发生率。结果 氧化亚氮组患者的术后苏醒时间和PACU停留时间均低于TIVA组［10.0(8.0,11.0)min比15.0(14.0,17.0)min、（28.2±2.7）min比（35.3±2.4）min］、恢复室最低血氧饱和度高于TIVA组［96.0%(95.0%,97.0%)比92.5%(92.0%,95.0%)］，术中麻黄碱的使用率低于TIVA组［3.3%(1/30)比23.3%(7/30)］，差异均有统计学意义(均P＜0.05)。2组不同时点的血流动力学指标、BS评分、总出血量和出血速度比较，差异均无统计学意义(均P＞0.05)。2组手术当天及术后第2天均未出现头晕、头疼和恶心呕吐等不良反应。结论 在老年鼻内镜手术患者中应用丙泊酚复合氧化亚氮静脉吸入复合麻醉，可达到与TIVA相似的手术条件，且可提供更稳定的血流动力学，在不增加不良反应的基础上苏醒时间更快。

• Objective  To investigate the effect and safety of intravenous inhalation of propofol combined with nitrous oxide combined anesthesia in elderly patients undergoing endoscopic sinus surgery. Methods Sixty elderly patients undergoing endoscopic sinus surgery under general anesthesia in Beijing Tongren Hospital, Capital Medical University from February 2022 to September 2023 were selected.According to the random number table method, they were divided into total intravenous anesthesia (TIVA) group and nitrous oxide group, with 30 cases in each group. Both groups received intravenous induction of general anesthesia with laryngeal mask airway. Anesthesia was maintained with propofol and remifentanil during operation in group TIVA; anesthesia was maintained by inhalation of propofol and remifentanil combined with nitrous oxide in the nitrous oxide group, and all patients recovered naturally after operation. The postoperative recovery time, post-anesthesia care unit (PACU) stay time and the lowest oxygen saturation value were recorded. Intraoperative hemodynamic changes and vasoactive drug usage were recorded. The Boezaart scale (BS) score of intraoperative blood loss, intraoperative blood loss volume and bleeding rate were recorded. The incidence of postoperative adverse reactions was recorded. Results The emergence time and PACU stay time in the nitrous oxide group were shorter than those in the TIVA group ［10.0(8.0,11.0)min vs 15.0(14.0,17.0)min,（28.2±2.7）min vs （35.3±2.4）min］, the lowest oxygen saturation in the recovery room was higher in the TIVA group［96.0%(95.0%,97.0%) vs 92.5%(92.0%,95.0%)］, and the intraoperative use of ephedrine was lower than that in the TIVA group［3.3%(1/30) vs 23.3%(7/30)］(all P＜0.05). There were no significant differences in hemodynamic parameters, BS score, total bleeding volume and bleeding velocity between the two groups at different time points (all P＞0.05). There were no adverse reactions such as dizziness, headache, nausea and vomiting in the two groups on the day of operation and the second day after operation. Conclusions The application of propofol combined with nitrous oxide intravenous inhalation combined anesthesia in elderly patients with endoscopic sinus surgery can achieve similar surgical conditions as TIVA, and can provide more stable hemodynamics, and faster recovery time without increasing adverse reactions.