全身麻醉患者复苏期气管拔管记忆的临床观察与研究

发布时间：2018-06-17 16:52

本文选题：脑电双频指数 + 浅麻醉状态　；参考：《广西医科大学》2017年硕士论文

【摘要】：目的:本课题通过对全身麻醉手术患者术后复苏,对不同苏醒状态下的病人进行围拔管期的观察。通过BIS监测、RASS评分、STEWARD评分、血氧饱和度等客观指标进行安全性评价;对心血管反应、拔管时间、拔管记忆、复苏舒适度、疼痛评分及术后并发症发生率等方面进行比较。研究拔管知晓和围拔管期不愉快记忆的相关因素,为制定更为人性、个体化拔管方案提供参考依据。方法:选择美国麻醉医师协会(ASA)I~II级,无明显心血管疾病、肥胖和通气功能障碍的手术病人全身麻醉气管拔管101例。两组患者的性别,ASA分级,体重,年龄,手术时长无明显差异。记录患者术前向患者和家属告知实验内容,术前完善相关检查,无明显困难气道与心胸疾病,无精神疾病和认知功能障碍。随机分为C组清醒拔管组81例,E组BIS监测下浅麻醉拔管组20例。数据收集完毕后,根据本研究所制定的记忆评分表,按照术后第一天的记忆评分将C组内分为C1组(术后记忆评分2分组)和C2组(术后记忆评分≥2分组)进行进一步讨论。于麻醉前(T0)、手术结束时(T1)、脱离呼吸机时(T2)、拔管时(T3)、拔管后5min(T4)、拔管后10min(T5)及出PACU时(T6)时点,记录心率(HR)收缩压(SBP)、舒张压(DBP)、平均动脉压(MAP)、血氧饱和度(SPO2)、脑电双频指数(BIS)、镇静程度评分(RASS评分)。记录出PACU时(T6)时点的动脉血气分析结果。详细记录患者民族、文化程度、文化程度与职业等基本信息,记录麻醉时长、手术时长、术中出血量、拔管后随即对患者进行疼痛评分和拔管记忆评分,拔管前随机出示一张图片让患者观察,并于术后一天询问是否记得,同时再次进行疼痛评分与拔管记忆评分,并询问患者是否存在咽痛、咳嗽、咳痰及头晕呕吐等症状。运用SPSS17.0统计软件对收集到的数据进行数据统计,对计量资料进行正态性分析,满足正态分布资料以均数士标准差表示,重复测量资料比较采用重复测量的方差分析,组间比较采用单因素方差分析,率的比较用卡方检验。P0.05为差异有统计学意义。结果:(1)C组与E组患者心率、平均动脉压和血氧饱和度的变化。组间比较:T2-T4时点C组MAP显著高于E组(P0.05);T3时间点C组HR显著高于E组,(P0.05);HR、MAP在其余时点比较差异无统计学意义,SPO2各时点比较差异无统计学意义(P0.05)。组内比较:两组各时点SPO2差异无统计学意义(P0.05)。C组MAP在T3时点显著高于其他时间点,与T0比较差异有统计学意义(P0.05),T1、T2和T4-T6与T0比较差异均无统计学意义(P0.05),E组各时间点MAP与T0比较均无统计学差异(P0.05)。C组HR除T3时点与T0比较差异有统计学意义(P0.05)外,其余时点与T0比较差异均无统计学意义。E组各时点与T0比较均无统计学意义(P0.05)。(2)C组与E组RASS评分的比较。组间比较:C组在T3、T4和T5时点RASS评分显著大于E组,组间比较差异有统计学意义(P0.05),其余时间点C组和E组RASS评分差异无统计学意义(P0.05)。组内比较:两组患者其余时点的RASS评分均显著大于T1,差异有统计学意义(P0.05)。(3)C组与E组T6时点动脉血氧分压、动脉血二氧化碳分压及氧合指数的比较。组间比较:T6时点C组与E组动脉血氧分压、动脉血二氧化碳分压、氧合指数比较差异无统计学意义(P0.05)。(4)C组与E组拔管时间、记忆评分、疼痛评分、是否术后镇痛、和术后并发症的比较。组间比较:E组拔管后记忆和术后一天记忆评分均显著低于C组,差异有统计学意义(P0.05);E组拔管时长短于C组,组间比较差异有统计学意义(P0.05)。两组间疼痛评分(手术当天疼痛评分和术后一天疼痛评分)、是否术后镇痛比较差异无统计学意义(P0.05)。E组咳嗽、咽痛、咳痰发生率显著低于C组,差异有统计学意义(P0.05),其余术后并发症组间比较差异无统计学意义(P0.05)。(5)C1和C2组间基本资料比较。两组一般资料比较差异无统计学意义(P0.05),C2的年龄小于C1组,差异有统计学意义(P0.05)。两组间麻醉时长、手术时长和出血量组间比较差异无统计学意义(P0.05),C2组体表手术较C1组多,组间比较差异有统计学意义(P0.05)。(6)C1和C2组间记忆和疼痛评分的比较。组间比较:两组间疼痛评分比较差异均无统计学意义(P0.05),C2组分组拔管时间长于C1组,差异有统计学意义(P0.05)。C2组术后镇痛显著少于C1组,差异有统计学意义(P0.05)。(7)C1组和C2组HR、MAP和SPO2的变化。组间比较:HR和MAP在各个时间点组间比较差异均无统计学差异(P0.05)。组内比较:C1组和C2组MAP在各个时点与T0比较差异均无统计学意义(P0.05),两组HR在T3时点均较T0时刻增大,差异有统计学意义(P0.05),其余时点HR与T0时点比较差异无统计学意义(P0.05)。(8)C1组和C2组RASS评分比较。组内比较:两组的RASS评分在T2-T6时间点均较T1时点显著更高,均在T6时刻接近0,各时点与T1比较差异均有统计学意义(P0.05)。组间比较:两组在T5时点比较差异有统计学意义(P0.05),其余时点组间比较差异无统计学意义(P0.05)。(9)C1与C2组间拔管时间、记忆评分和疼痛评分、术后镇痛的比较。两组间疼痛评分比较差异无统计学意义(P0.05),C2组拔管时间显著长于C1组,差异有统计学意义(P0.05)。C2组术后镇痛例数显著低于于C1组,差异有统计学意义(P0.05)。(10)除咳痰外,两组术后并发症组间比较差异无统计学意义(P0.05),C1组的术后并发症中咳痰发生率低于C2组,差异有统计学意义(P0.05)。结论:1、BIS值65-75拔除气管导管,可消除全麻复苏患者拔管的不良记忆,是一种安全舒适的全麻复苏技术。2、术后镇痛有助于消除拔管不良记忆。
[Abstract]:Objective: To observe the peri - extubation period of patients with different revival state through the resuscitation after general anesthesia, through BIS monitoring, RASS score, STEWARD score, blood oxygen saturation and other objective indexes, and the cardiovascular response, extubation time, extubation memory, resuscitation comfort, pain score and postoperative The relative factors of the incidence of complications were compared. The related factors of unpleasant memory in extubation awareness and peri extubation period were studied to provide a reference for making a more human and individualized extubation scheme. Methods: select the American anesthesiologist Association (ASA) I~II, with no significant cardiovascular disease, obesity and ventilatory dysfunction. There were 101 cases of tube extubation. There were no significant differences in sex, ASA classification, weight, age, and length of operation in the two groups. The patients and their families were informed of the experimental contents before operation. Before the operation, the patients were informed of the experimental contents, the airway and cardiothoracic diseases, no mental illness and cognitive impairment were not obvious before the operation. 81 cases were divided into group C sober extubation group, and E group was monitored under BIS monitoring. 20 cases in the shallow anaesthetized extubation group. After the data collection, according to the memory score made in this study, the C group was divided into group C1 (2 groups after operation memory score) and group C2 (postoperative memory score > 2). Before anesthesia (T0), at the end of the operation (T1), out of the ventilator (T2), extubation Time (T3), 5min (T4) after extubation, 10min (T5) and PACU (T6) point after extubation, record heart rate (HR) systolic pressure (SBP), diastolic pressure (DBP), mean arterial pressure (MAP), oxygen saturation (SPO2), EEG double frequency index, and degree of sedation. Degree, degree of education and occupation, record the length of anaesthesia, the length of the operation, the amount of bleeding in the operation, the pain score and the extubation memory score of the patients immediately after extubation, a picture before the extubation was given to the patients to be observed, and one day after the operation, whether the patient was remembered, and the pain score and the extubation memory score were also carried out again. Ask the patient whether there are symptoms of sore throat, cough, expectoration, dizziness, vomiting and other symptoms. SPSS17.0 statistics software is used to carry out data statistics on collected data, carry on normal analysis to the measurement data, meet normal distribution data with the standard deviation of the number of men, repeated measurement data compared with the repeated measurement of variance analysis, and comparison among groups. Using single factor analysis of variance, the comparison of the ratio with chi square test.P0.05 was statistically significant. Results: (1) heart rate, mean arterial pressure and blood oxygen saturation in group C and E group. Group MAP was significantly higher than group E (P0.05) in C group at T2-T4 point, and HR in T3 time point C group was significantly higher than that in E group. There was no statistical significance (P0.05) at each time point of SPO2. There was no statistically significant difference between the two groups at each time point (P0.05) and the MAP in the.C group was significantly higher than the other time points in T3 point, and there was a significant difference between T0 and T0 (P0.05), T1, T2 and T4-T6 and T4-T6. There was no statistical difference between group 0 and T0 in group.C (P0.05). There was no significant difference between T0 and T0 in group.C (P0.05). There was no statistically significant difference between the other time points and T0 (P0.05). (P0.05). (2) the comparison between C and E groups. There was significant difference between groups (P0.05), and there was no significant difference in RASS score between group C and E at the rest of time (P0.05). In group two, the other time points were significantly higher than T1, and the difference was statistically significant (P0.05). (3) the arterial oxygen pressure, the partial pressure of carbon dioxide in the arterial blood and the oxygenation index in the C group and E group T6 time. Comparison: comparison between groups: there was no significant difference in oxygen pressure between group C and group E at T6 time and E group, the partial pressure of carbon dioxide in arterial blood, and no significant difference in oxygenation index (P0.05). (4) the time of extubation, memory score, pain score, postoperative analgesia, and postoperative complications were compared between group C and group E. The comparison between group E and postoperative memory scores in E group and postoperative memory scores were all Significantly lower than the C group, the difference was statistically significant (P0.05), in group E, when extubation was in group C, there was a significant difference between groups (P0.05). Two groups of pain scores (pain scores and one day pain score after operation), and whether postoperative analgesia was not statistically significant (P0.05) the incidence of cough, sore throat, and expectoration in group.E was significantly lower than that of C. The difference was statistically significant (P0.05), and there was no significant difference between the other postoperative complications groups (P0.05). (5) the basic data of group C1 and C2 were compared. The general data of the two groups had no statistical significance (P0.05), the age of C2 was less than the C1 group, and the difference was statistically significant (P0.05). The length of anesthesia between the two groups, the length of the operation and the volume of bleeding were between the groups. There was no statistically significant difference (P0.05), and there was a significant difference between group C2 and group C1 (P0.05). (6) the comparison of memory and pain scores between groups of C1 and C2. There was no statistical difference between groups (P0.05), and the extubation time of group C2 group was longer than that in group C1 (P0.05). Group.C2 postoperative analgesia was significantly less than group C1, the difference was statistically significant (P0.05). (7) the changes of HR, MAP and SPO2 in group C1 and C2 group. There was no statistical difference between the groups of HR and MAP in each time point group (P0.05). The difference was statistically significant (P0.05), and there was no significant difference between HR and T0 at the other time points (P0.05). (8) the RASS scores of group C1 and C2 group were compared. The RASS scores in the two groups were significantly higher in T2-T6 time points than in T1 time points, and both were close to 0 at the moment of T6, and there were significant differences in each time point. 0.05) comparison: there was a significant difference between the two groups at T5 time points (P0.05), and there was no significant difference between the other time points (P0.05). (9) the extubation time between the C1 and C2 group, the memory score and the pain score, and the postoperative analgesia were compared. There was no statistical difference between the two groups (P0.05), and the extubation time in the C2 group was significantly longer than C1. Group, the difference was statistically significant (P0.05) the number of postoperative analgesia in group.C2 was significantly lower than that in group C1 (P0.05). (10) except for expectoration, there was no significant difference in postoperative complications between the two groups (P0.05), and the incidence of expectoration in group C1 was lower than that in group C2 (P0.05). Conclusion: 1, BIS value 65-75. The removal of tracheal catheter can eliminate the bad memory of extubation in patients with general anesthesia. It is a safe and comfortable general anesthesia recovery technique.2. Postoperative analgesia helps to eliminate the bad memory of extubation.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614

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