Lidocaine Combined With Nitroglycerin For Functional Endoscopic Surgery Clinical Observation Of Controlled Hypotension

Objective:To observe the efficacy and safety of lidocaine combined with nitroglycerin for controlled hypotension in functional endoscopic sinus surgery.Methods:In this study,60 patients with elective endoscopic open sinus surgery in the whole group were selected,aged 25-55 years,weight 50-80 kg,ASA grade I ～ II.All patients were randomly divided into lidocaine combined with nitroglycerin group(observation group)and nitroglycerin alone group(control group)using a randomized table.Observation group: 30 cases were given lidocaine combined with nitroglycerin,and were pumped with lidocaine after endotracheal intubation until the end of operation.Control group: 30 patients were given normal saline combined with nitroglycerin,and the same amount of normal saline was pumped after endotracheal intubation until the end of operation.Patients in both groups were treated with the same anesthetic induction method,controlled hypotension operation was started 10 minutes before surgery,nitroglycerin was pumped,and the pumping rate was adjusted according to the mean arterial pressure,so that the target MAP was reduced to60-70 mm Hg or 30% lower than before induction,but not less than 60 mm Hg.Nitroglycerine was discontinued at the end of the major surgical procedure and the beginning of nasal filling.Observation records of patients with different time node has a mean arterial pressure(MAP),heart rate(HR),records of target blood pressure in patients with time,recovered to preoperative levels of blood pressure after discontinuation of time,intraoperative blood loss,intraoperative vision clarity grading,intraoperative nitroglycerin,propofol,remifentanil and total patients with postoperative extubation time.Results:1.General situation: there was no significant difference in sex,age,height,weight and body mass index between the two groups(p﹥0.05);2.Hemodynamics: T2 ～ T5 moment between the two way compared to the MAP,there was no statistically significant difference(P > 0.05),the observation group of T2 to T5 HR and the control group is significantly lower than the moment,the difference was statistically significant(P < 0.05),the observation group T7 has time HR,MAP,and the control group is significantly lower than the moment,the difference was statistically significant(P < 0.05);3.Antihypertensive effect: in the observation group,the time to reach the target blood pressure was shorter than that in the control group,and the intraoperative blood loss and intraoperative visual field clarity were better than those in the control group,with statistical significance(P < 0.05);4.Intraoperative drug use: Compared with the control group,the intraoperative drug doses of nitroglycerin,propofol and remifentanil in the observation group were significantly decreased,with statistical significance(P < 0.05);5.Postoperative situation: There was no statistical significance in the recovery time after drug withdrawal and postoperative extubation time between the two groups(P > 0.05);Conclusions:Intravenous application of lidocaine combined with nitroglycerin in functional nasal endoscopic surgery has satisfactory controlled hypotension effect and stable hemodynamics,which can effectively improve intraoperative field of vision and reduce intraoperative bleeding,and reduce the dosage of general anesthesia drugs and opiates.