喉罩通气过渡在胸科手术麻醉苏醒拔管期的应用

发布时间：2018-03-10 18:47

本文选题：胸科手术　切入点：双腔支气管导管　出处：《海南医学》2016年20期 　论文类型：期刊论文

【摘要】：目的比较胸科手术患者双腔支气管导管麻醉苏醒拔管期不同拔管方式对血流动力学及不良反应的影响,以探讨喉罩通气过渡在双腔支气管导管拔管期的应用价值。方法将我院2015年2月至2016年2月期间120例全身麻醉双腔支气管导管插管的胸科手术患者根据随机数字表随机分成A、B、C、D四组,每组30例。其中A组患者在手术结束后符合拔管条件时直接拔除双腔支气管导管,B组患者在手术结束时深麻醉下将双腔支气管导管退至总气管,C组术毕时在深麻醉下将双腔管更换为单腔气管导管,D组在深麻醉下更换为喉罩;各组均待患者神志清醒、循环呼吸功能稳定后拔除气管导管或喉罩。比较四组患者入手术室时(T0)、拔管或喉罩前吸痰时(T1)、拔管或喉罩后即刻(T2)、拔管或喉罩后5 min(T3)、10 min(T4)等各时点的平均动脉压(MAP)、心率(HR)、BIS值、血氧饱和度(Sp O2)的差异情况,并记录麻醉苏醒期患者呛咳、躁动等不良反应发生情况并进行分析。结果 T0时,A、B、C、D四组患者MAP分别为(80.1±8)mm Hg、(81.2±10)mm Hg、(78.2±12)mm Hg、(80.6±11)mm Hg,HR分别为(75.2±5)次/min、(74.3±6)次/min、(73.8±8)次/min、(74.8±9)次/min,T1时,A、B、C、D四组患者MAP分别为(114.3±6)mm Hg、(103.2±9)mm Hg、(92.2±10)mm Hg、(83.2±10)mm Hg,HR分别为(97.3±8)次/min、(92.4±6)次/min、(84.5±10)次/min、(75.3±11)次/min,T2时,A、B、C、D四组患者MAP分别为(115.2±13)mm Hg、(108.3±10)mm Hg、(90.2±9)mm Hg、(83.8±12)mm Hg,HR分别为(99.2±11)次/min、(93.5±8)次/min、(83.3±6)次/min、(76.3±8)次/min,T3时,A、B、C、D四组患者MAP分别为(105.6±11)mm Hg、(108.3±10)mm Hg、(88.2±7)mm Hg、(81.8±9)mm Hg,HR分别为(95.3±10)次/min、(83.4±7)次/min、(80.7±9)次/min、(74.3±10)次/min。与T0比较,A、B、C三组T1、T2、T3各时点MAP、HR均明显增高,且明显高于D组,差异均有统计学意义(P0.05);四组患者各时点的BIS值及Sp O2比较差异均无统计学意义(P0.05);A、B、C三组患者出现呛咳例数分别为24例、20例、12例,发生率分别为80.000%、66.667%、40.000%,发生躁动分别为19例、13例、6例,发生率分别为63.333%、43.333%、20.000%,而D组患者均未发生,与D组比较差异有统计学意义(P0.05)。结论胸科手术患者双腔支气管导管拔管时更换喉罩通气过渡后拔管可以减轻全麻苏醒拔管期血流动力学波动,降低苏醒期不良反应,使患者麻醉苏醒过程更加安全舒适。
[Abstract]:Objective to compare the effects of different extubation methods on hemodynamics and adverse reactions in patients undergoing double lumen bronchial catheter anesthesia during extubation stage. To explore the application value of laryngeal mask ventilation transition in the stage of double lumen bronchial catheter extubation methods 120 patients undergoing general anesthesia and double lumen bronchial catheter intubation from February 2015 to February 2016 in our hospital were treated by random numbers. The table was randomly divided into four groups, namely, Acarb Con D group. There were 30 cases in each group. Group A patients who met the conditions of extubation after operation were directly removed from double lumen bronchial ducts. The patients in group B retreated under deep anesthesia at the end of the operation to the total trachea group C at the end of operation under deep anesthesia. After intoxication, the double lumen tube was replaced by the laryngeal mask in group D under deep anesthesia. All the patients in each group were conscious, Tracheal catheter or larynx mask was removed after stable circulatory and respiratory function. The mean arterial pressure (MAPP), heart rate (HRV) and BIS were compared between the four groups at different time points, such as T0, T1, T2, T3 and T4, respectively, at the time of entering the operating room before extubation or larynx mask, immediately after extubation or larynx mask, 5 min after extubation or larynx mask. The difference of blood oxygen saturation (Sp / O _ 2) and cough in patients during anaesthesia recovery were recorded. Results the incidence of adverse reactions such as restlessness was analyzed. Results the MAP of the four groups at T0 was 80.1 卤81.2mm 卤81.2mm Hgtrop, 78.2 卤12mm 卤12Omm Hgtrop, 75.2 卤5mm, 74.3 卤6min, 73.8 卤8min, 74.8 卤94.8min / min, 74.8 卤94.8mm / min, 114.3 卤61mm / 103.2 卤92.2 卤92mm / 10mm / h / h, respectively, respectively, and the MAP of the fourth group was 114.3 卤610mm / h / g ~ 103.2 卤92.2 卤92.2 卤10mm / 10mm / h / h / h, respectively, respectively, = 97.3 卤87.3 卤82.4 / 10mm / 6min) / 6min 卤6min / 6h / r = 92.4 卤6min / 6mg / r = 92.2 卤92.2 卤92.2 卤10mm / 10mm / h / h, respectively. The MAP of the four groups were 114.3 卤61mm / 103.2 卤92.2 卤92.2 卤92.2 卤10mm / 10mm / h and 97.3 卤87.3 卤87.3 卤82.4 / 6min / 6min, respectively. The MAP of the four groups were 115.2 卤13.3 卤108.3mm 卤108.2mm 卤90.2mm 卤12mm respectively, and 83.8 卤12mm (99.2 卤12mm) / min (93.5 卤83.5 卤83.53 卤6min), respectively. The MAP of the four groups were 105.6 卤11.3 卤11mm Hgtrop, 108.3 卤108.2mm 卤98.2mm 卤93.4mm 卤83.4 卤8min, respectively, and the MAP of the four groups were significantly higher than that of the control group (105.6 卤11mm Hg / g = 108.3mm 卤98.2mm 卤93.4 卤8min / 8min), respectively. The MAP of the four groups was significantly higher than that of the control group (P / min = 74.3 卤118.2mm 卤108.2mm 卤98.2mm 卤93.3t 卤8min, respectively). The MAP of the four groups was significantly higher than that of the control group (P < 0.01). The MAP of the four groups was significantly higher than that of the control group (P < 0.05 卤13.3 卤108.3 卤108.3 卤108.2mm 卤98.2mm 卤98.2mm 卤93.4t 卤8min, respectively). The mean MAP of the four groups was significantly higher than that of the control group (P < 0.05 卤83.3 卤6p / min, P / min = 73.3 卤6t = 76.3 卤86.3T 3, respectively). The MAP of the four groups was 105.6 卤11.3 mm 卤108.2mm 卤108.2mm 卤98.2mm 卤98.2mm 卤93.4 卤8min 卤8min respectively. There was no significant difference in BIS value and SPO _ 2 between the four groups at each time point, and there was no significant difference in the number of choking and coughing in the three groups (24 cases, 20 cases, 12 cases, respectively), which were significantly higher than those in group D (P 0.05), and there was no significant difference between the four groups in terms of BIS and SPO 2. The incidence rates were 80.000, 66.667and 40.000, respectively. The incidence of restlessness was 19 cases, 13 cases and 6 cases, respectively. The incidence rate was 63.333 and 43.333, respectively, but none of the patients in group D had occurred. Conclusion the change of laryngeal mask ventilation and extubation after laryngeal mask ventilation in patients undergoing thoracic surgery can reduce hemodynamic fluctuation and reduce adverse reactions during general anesthesia. Make patient anaesthesia awake process safer and more comfortable.
【作者单位】：厦门市第二医院麻醉科;
【分类号】：R614

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