The Quality of the Surgical Field During Functional Endoscopic Sinus Surgery-The Effect of the Mode of Ventilation: A Randomized, Prospective, Double-Blind Study
The Quality of the Surgical Field During Functional Endoscopic Sinus Surgery-The Effect of the Mode of Ventilation: A Randomized, Prospective, Double-Blind Study
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DOI：
10.1002/lary.20614
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发表时间：
2009-12-01
期刊：
影响因子：
2.6
通讯作者：
Ivry, Simon
中科院分区：
文献类型：
--
作者：
Gilbey, Peter;Kukuev, Yevgeny;Ivry, Simon
目标/假设：功能性内窥镜鼻窦手术 (FESS) 的结果取决于通过最大限度地减少术中出血而实现的清洁手术区域。由于气道压力较低，高频喷射通气 (HFJV) 具有改善静脉回流、减少出血和改善操作条件的优点。通过评估手术条件和测量术中失血量，将 HFJV 与间歇性正压通气 (IPPV) 进行比较。研究设计：前瞻性、随机、双盲研究。方法：共有 22 名接受 FESS 的患者被随机分配在全身麻醉下手术期间使用 HFJV 或 IPPV 进行通气。评估手术区域的质量并测量总失血量。结果：HFJV 组的平均气道压力显着低于 IPPV 组（分别为 2.42 +/- 1.17 和 7.11 +/- 0.72，P < .0001）。 HFJV 组的总平均失血量为 170 cc，IPPV 组的平均失血量为 318.18 cc (P = .017)。外科医生估计的 HFJV 组手术视野质量明显更好。 Boezaart 等人的平均分值。 IPPV 组和 HFJV 组的评分分别为 2.72 +/- 0.77 和 1.80 +/- 0.686 (P = .012)。结论：HFJV 显着减少了术中出血量，从而显着改善了手术区域的质量。有人认为，由于胸腔内压力较低，静脉回流增加，从而减少了出血并改善了手术条件。 HFJV 可有效用于 FESS，以改善内窥镜视野，且无不良影响。
Objectives/Hypothesis: The outcome of functional endoscopic sinus surgery (FESS) depends on a clean surgical field achieved by minimizing intraoperative bleeding. High frequency jet ventilation (HFJV), due to lower airway pressures, offers the benefit of improved venous return, less bleeding, and improved operating conditions. HFJV was compared to intermittent positive pressure ventilation (IPPV) by assessment of surgical conditions and measurement of intraoperative blood loss.Study Design: Prospective, randomized, double-blind study.Methods: A total of 22 patients undergoing FESS were randomly assigned to be ventilated during surgery under general anesthesia by either HFJV or IPPV. The quality of the surgical field was assessed and the total blood loss was measured.Results: The mean airway pressure was significantly lower in the HFJV group than in the IPPV group (2.42 +/- 1.17 and 7.11 +/- 0.72, respectively, P < .0001). The total mean loss of blood in the HFJV group was 170 cc and in the IPPV group was 318.18 cc (P = .017). The quality of the surgical field as estimated by the surgeon was significantly better in the HFJV group. The mean point values on the Boezaart et al. scale for the IPPV and HFJV groups were 2.72 +/- 0.77 and 1.80 +/- 0.686, respectively (P = .012).Conclusions: HFJV significantly reduced the amount of intraoperative bleeding and thus significantly improved the quality of the surgical field. It is suggested that increased venous return due to lower intrathoracic pressures resulted in less bleeding and improved operating conditions. HFJV can be effectively used for FESS in order to improve endoscopic view with no adverse effects.