鼻内镜手术围手术期低血压的危险因素及多学科综合管理

Perioperative hypotension in endoscopic sinus surgery: Risk factors and multidisciplinary management

摘要:

鼻内镜手术(ESS)围手术期（简称围术期）低血压是临床常见的并发症，其发生与手术操作、麻醉管理及局部用药等多因素交互作用有关。本文基于文献回顾，旨在对ESS围术期低血压的危险因素、发生机制及综合管理策略进行综述。ESS围术期低血压的主要危险因素包括手术操作触发的三叉神经心脏反射(TCR)、局部肾上腺素全身吸收导致的β2受体介导的反跳性低血压、麻醉药物（如丙泊酚、高剂量瑞芬太尼）的影响以及患者因素（如高龄、合并心血管疾病），其管理策略强调多学科协作，涵盖术前风险评估与循环优化、术中动态监测与分级药物干预及术后严密观察，实施综合性管理策略可有效降低低血压发生风险。未来应致力于构建基于中国人群的风险预测模型，并探索新型止血材料及中西医结合等替代方案。

Abstract:

Perioperative hypotension is a common clinical complication in endoscopic sinus surgery (ESS). Its occurrence is arising from the complex interplay of surgical manipulation, anesthetic management, and local medication administration. Based on a literature review, this narrative review aims to summarize the risk factors and mechanisms of perioperative hypotension, as well as management strategies in ESS. The main risk factors include surgical triggers such as the TCR (Trigeminocardiac Reflex), systemic absorption of topical epinephrine leading to β2-receptor-mediated rebound hypotension, the effects of anesthetic agents (e.g., the vasodilatory effect of propofol, high-dose remifentanil), and patient-related factors (e.g., older age, comorbid cardiovascular diseases). Management strategies emphasize multidisciplinary collaboration, encompassing preoperative risk assessment and circulatory optimization, intraoperative dynamic monitoring with stepwise pharmacological intervention, and rigorous postoperative observation. The implementation of comprehensive management strategies can effectively reduce the risk of hypotension. Future efforts should focus on developing risk prediction models based on the Chinese population and exploring alternative approaches such as novel hemostatic materials and the integration of traditional Chinese and Western medicine.