全麻醉诱导期不同通气方式对胃体积变化的影响

发布时间：2018-06-09 16:06

本文选题：腹部超声 + 胃体积　；参考：《贵州医科大学》2017年硕士论文

【摘要】：目的:探讨腹部超声监测下全身麻醉诱导期不同通气方式前、后胃体积的改变,为饱胃患者实施全身麻醉诱导时选择何种通气方式提供一定临床依据。方法:选择2015年6月~11月我院70例ASA分级为:I~II级,年龄:20~60岁,身高:151~176cm,体重:40kg~65kg,Mallampati分级为Ⅰ~Ⅱ级,拟施行四肢骨科手术的非妊娠患者,分为七个组,每组均为10例,男、女不限,分别为:A1组、A2组、A3组、A4组以及B1组、B2组、B3组。其中,A组均为急诊手术患者共40例:禁食禁饮时间均大于4h,小于8h,将其随机分为A1组、A2组、A3组和A4组。A1组患者全身麻醉诱导时采用常规正压通气方式;A2组患者全身麻醉诱导期采用高频率、低潮气量通气方式;A3组患者全身麻醉诱导期采用预充氧无正压通气方式;A4组患者全身麻醉诱导前均留置胃、肠减压管并连接负压引流瓶,其余处理措施均与A1组患者完全相同。B组为择期手术患者共30例,禁食禁饮时间均大于8h,将其随机分为:B1组、B2组、B3组。B1组、B2组、B3组全身麻醉诱导期通气方式分别与A1组、A2组、A3组患者完全相同。施行全身麻醉前所有患者均由同一名医生行腹部超声检查寻找胃窦,并测量其面积;全身麻醉行气管插管后,由该医生再次行腹部超声检查寻找胃窦并测量其面积。研究全过程中,全身麻醉诱导前或麻醉后,不能获得良好切面者及气管插管次数1次的病人被排除在外。运用相关公式通过胃窦面积换算出胃的体积,将全身麻醉诱导前胃体积标记为V1;全身麻醉诱导气管插管后的胃体积标记为V2。结果:70例被纳入研究的患者,气管插管均为一次成功,每例患者均能获得良好的胃窦切面,无患者发生反流、误吸。各组内麻醉诱导前、后胃体积比较:A1、A2、A4、B1、B2组V2与V1比较,差异具有统计学意义(P0.05),提示:V2明显大于V1;A3、B3组V2与V1比较,差异无统计学意义(P0.05),提示:V2较V1无明显变化。各组间V1的比较,差异无统计学意义;各组间V2的比较:A1、A2、A4、B1、B2组与A3、B3组间比较差异有统计学意义(P0.05),其余两两比较差异无统计学意义,提示:A1、A2、A4、B1、B2组V2值较A3、B3组大;7组间V2与V1差值比较:A1、A2、A4、B1、B2组与A3、B3组间比较差异有统计学意义(P0.05),其余两两比较差异无统计学意义,提示:A1、A2、A4、B1、B2组V2与V1差值较A3、B3组大;各组内患者基础SPO2与气管插管成功时SPO2比较,差异无统计学意义(P0.05);各组间患者的基础SPO2、气管插管成功时的SPO2比较差异无统计学意义(P0.05)。结论:全身麻醉诱导期间,预充氧无正压通气的方式,对胃体积改变的影响最小。
[Abstract]:Objective: To investigate the changes of the volume of the stomach before the induction of general anesthesia in the induction period of general anesthesia under abdominal ultrasonic monitoring, and to provide a certain clinical basis for the selection of ventilation mode in the induction of general anesthesia in the patients with full stomach. Methods: 70 cases of ASA in our hospital in June 2015 ~11 month were classified as I ~II, age: 20~60 years, height: 151~176cm, weight: 40kg~65 Kg, Mallampati was classified as grade I to II. The non pregnant women who were to be operated on the extremities Department of orthopedics were divided into seven groups. Each group was divided into 10 cases, male and female, respectively: group A1, group A2, A3 group, A4 group, B1 group, B2 group and B3 group. Among them, the A group were 40 cases of emergency operation: the time of fasting prohibition was larger than 8h. In group A4 and group.A1, conventional positive pressure ventilation was used in the induction of general anaesthesia in group A2; high frequency and low tidal volume ventilation were used in the induction period of general anesthesia in group A2; group A3 patients were induced by pre oxygenation without positive pressure ventilation; in group A4, the stomach, intestinal decompression tube and negative pressure drainage bottle were retained before induction of general anesthesia. The rest of the treatment measures were all the same as group A1 patients in group.B for 30 cases of elective surgery. The time of fasting prohibition was greater than 8h. They were randomly divided into B1 group, B2 group, B3 group.B1 group, B2 group, and B3 group induction period of general anesthesia induction period were the same as A1 group, A2 group and A3 group. All patients before general anesthesia were the same doctor before general anesthesia. Abdominal ultrasonography was used to find the gastric antrum, and the area was measured. After general anaesthesia, the doctor looked for the antrum and measured the area of the gastric antrum again. In the whole process, before or after the induction of general anesthesia, the patients who were unable to obtain a good face and 1 times of tracheal intubation were excluded. The volume of gastric antrum was converted through the area of the gastric antrum, the volume of the gastric volume was marked as V1 by general anesthesia, and the volume of the gastric volume after the induction of tracheal intubation by general anesthesia was V2.: 70 cases of the patients who were included in the study were all successful, each patient was able to get good gastric antral cut surface, no reflux and mistaken aspiration of the patients. Before anesthesia induction, the volume of the posterior stomach was compared: A1, A2, A4, B1, and B2 group V2 compared with V1, the difference was statistically significant (P0.05), suggesting that V2 was significantly greater than V1; A3, there was no significant difference in the difference between B3 groups. The difference between the B3 groups was statistically significant (P0.05), and the other 22 had no statistical significance, suggesting that A1, A2, A4, B1, the V2 value of the B2 group was larger than the A3 and B3 group, and the difference between the 7 groups was statistically significant. The difference between the V1 and the B3 group was larger than that in the group of A3 and B3, and there was no significant difference between the basal SPO2 and the tracheal intubation in each group (P0.05). The basal SPO2 in each group was not statistically significant (P0.05) in the success of tracheal intubation (P0.05). Conclusion: during the period of general anesthesia induction, the mode of pre oxygenation without positive pressure ventilation and the change of the volume of the stomach The influence is minimal.
【学位授予单位】：贵州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R614.2

【参考文献】