不同通气方式对髋关节置换高血压患者应激反应的影响

发布时间：2018-01-15 20:02

本文关键词：不同通气方式对髋关节置换高血压患者应激反应的影响　出处：《中国组织工程研究》2015年35期 　论文类型：期刊论文

【摘要】：背景:髋关节置换患者全麻时,气管插管可造成咽喉和气管感受器的物理刺激,会引起患者的应激反应增强,尤其是高血压患者。Supreme喉罩能够减轻围术期患者心血管应激反应,降低气道并发症。目的:观察Supreme喉罩和气管插管对高血压患者髋关节置换应激反应的影响。方法:取2010年1月至2014年9月于江苏省沭阳仁慈医院行人工髋关节置换的患者45例,采用随机数字表法将患者均分为两组,喉罩组23例,气管插管组22例。两组患者均采用相同的麻醉诱导和维持方法,置换过程中连续监测患者的收缩压、舒张压、心率及血氧饱和度,分别记录两组麻醉诱导前(T0)、插管(喉罩)后即刻(T1)、5 min(T2)、15 min(T3)时收缩压、舒张压、血氧饱和度、心率及血糖、血浆肾上腺素、去甲肾上腺素、血清皮质醇、血管紧张素Ⅱ及心钠素水平。结果与结论:喉罩组患者收缩压与舒张压在T1-T3时间点较T0时明显降低(P0.05);心率、血氧饱和度在T0-T3各时间点比较平稳,差异无显著性意义(P0.05)。气管插管组患者收缩压、舒张压在T1时较T0时显著升高,收缩压在T2、T3时较T0明显降低,舒张压在T3时较T0显著降低(P0.05),心率、血氧饱和度在T1时间点显著升高(P0.05)。与T组比较,喉罩组患者收缩压与舒张压在T1-T3时间点显著降低(P0.05),心率在T1、T2较T组明显减慢(P0.05),血氧饱和度在T1显著高于T组(P0.05)。与T0时比较,T1-T3时气管插管组血糖、血浆肾上腺素、去甲肾上腺素浓度和皮质醇含量明显升高,且显著高于喉罩组(P0.05)。T1-T3时气管插管组血管紧张素Ⅱ水平较T0时显著增高,且均高于喉罩组。T1-T3时两组心钠素含量明显升高,气管插管组显著高于喉罩组(P0.05)。可见喉罩对于这些与应激相关的生化指标的影响较小,这也是其对患者血流动力学影响较小的生理基础。提示与气管插管比较,喉罩可明显减轻高血压患者全麻状态下髋关节置换时的应激反应。
[Abstract]:Background: general anesthesia for hip replacement patients, physical tracheal intubation can cause throat and trachea receptor stimulation, can cause increased stress response in patients, especially in patients with hypertension.Supreme laryngeal mask can reduce perioperative cardiovascular stress, reduce airway complications. Objective: To observe the effect of Supreme laryngeal mask and tracheal intubation in patients with hypertension total hip arthroplasty stress. Methods: from January 2010 to September 2014 at Mercy Hospital in Shuyang, Jiangsu province of hip replacement patients 45 cases, were randomly divided into two groups of patients, 23 cases of laryngeal mask group, tracheal intubation group of 22 cases. Two patients were treated with the same anesthesia induction and maintenance. The monitoring of patients with systolic blood pressure, diastolic blood pressure continuously during surgery, heart rate and oxygen saturation were recorded in two groups before induction of anesthesia (T0), immediately after intubation (LMA) (T1), 5 min (T2), 15 m In (T3) and systolic blood pressure, diastolic blood pressure, oxygen saturation, heart rate and blood glucose, plasma epinephrine, norepinephrine, cortisol, angiotensin II and ANP. Results and conclusion: LMA group patients with systolic blood pressure and diastolic blood pressure in T1-T3 compared with T0 significantly decreased (P0.05); heart rate oxygen saturation in T0-T3 at each time point is relatively stable, no significant difference (P0.05). Tracheal intubation in patients with systolic blood pressure, diastolic blood pressure in T1 compared with T0 significantly increased, systolic blood pressure at T2, T3 was significantly lower than that in T0, diastolic blood pressure in T3 compared with T0 significantly decreased (P0.05), heart rate and oxygen saturation was significantly increased in T1 time point (P0.05). Compared with T group, the LMA group systolic blood pressure and diastolic blood pressure in the T1-T3 time point was significantly decreased (P0.05), heart rate at T1, T2 was significantly slower than T (P0.05), blood oxygen saturation in T1 was significantly higher than that of T group (P0.05). With T0, T1-T3 intubation Blood glucose, plasma epinephrine, norepinephrine and cortisol concentrations were significantly increased, and significantly higher than the LMA group (P0.05).T1-T3 intubation group angiotensin II levels were increased at T0, and were higher than the LMA group.T1-T3 two group ANP increased significantly, tracheal intubation group was significantly higher than that of LMA group (P0.05). The visible laryngeal mask has little effect on these and stress related biochemical indexes, which is its influence on hemodynamics and physiological basis of smaller. Compared with tracheal intubation tips, laryngeal mask can significantly reduce the stress response of patients with hypertension under general anesthesia during hip replacement.

【作者单位】：江苏省沭阳仁慈医院麻醉科;徐州医学院附属淮安市第二人民医院;
【分类号】：R614
【正文快照】： ISSN 2095-4344 CN 21-1581/R CODEN:ZLKHAH 55890引言Introduction髋部骨折是高龄患者脆性骨折的最常见类型,其主要原因是骨质疏松,老年人反应迟缓,自愈能力差,遇到轻微外力即可引起骨折[1-2]。随着中国人口老龄化加剧和预期寿命增加,股骨颈骨折患者必将大量增加。髋关节置换

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