發(fā)布時間：2018-03-10 18:47

  本文選題：胸科手術(shù)　切入點(diǎn)：雙腔支氣管導(dǎo)管　出處：《海南醫(yī)學(xué)》2016年20期 　論文類型：期刊論文

【摘要】：目的比較胸科手術(shù)患者雙腔支氣管導(dǎo)管麻醉蘇醒拔管期不同拔管方式對血流動力學(xué)及不良反應(yīng)的影響,以探討喉罩通氣過渡在雙腔支氣管導(dǎo)管拔管期的應(yīng)用價值。方法將我院2015年2月至2016年2月期間120例全身麻醉雙腔支氣管導(dǎo)管插管的胸科手術(shù)患者根據(jù)隨機(jī)數(shù)字表隨機(jī)分成A、B、C、D四組,每組30例。其中A組患者在手術(shù)結(jié)束后符合拔管條件時直接拔除雙腔支氣管導(dǎo)管,B組患者在手術(shù)結(jié)束時深麻醉下將雙腔支氣管導(dǎo)管退至總氣管,C組術(shù)畢時在深麻醉下將雙腔管更換為單腔氣管導(dǎo)管,D組在深麻醉下更換為喉罩;各組均待患者神志清醒、循環(huán)呼吸功能穩(wěn)定后拔除氣管導(dǎo)管或喉罩。比較四組患者入手術(shù)室時(T0)、拔管或喉罩前吸痰時(T1)、拔管或喉罩后即刻(T2)、拔管或喉罩后5 min(T3)、10 min(T4)等各時點(diǎn)的平均動脈壓(MAP)、心率(HR)、BIS值、血氧飽和度(Sp O2)的差異情況,并記錄麻醉蘇醒期患者嗆咳、躁動等不良反應(yīng)發(fā)生情況并進(jìn)行分析。結(jié)果 T0時,A、B、C、D四組患者M(jìn)AP分別為(80.1±8)mm Hg、(81.2±10)mm Hg、(78.2±12)mm Hg、(80.6±11)mm Hg,HR分別為(75.2±5)次/min、(74.3±6)次/min、(73.8±8)次/min、(74.8±9)次/min,T1時,A、B、C、D四組患者M(jìn)AP分別為(114.3±6)mm Hg、(103.2±9)mm Hg、(92.2±10)mm Hg、(83.2±10)mm Hg,HR分別為(97.3±8)次/min、(92.4±6)次/min、(84.5±10)次/min、(75.3±11)次/min,T2時,A、B、C、D四組患者M(jìn)AP分別為(115.2±13)mm Hg、(108.3±10)mm Hg、(90.2±9)mm Hg、(83.8±12)mm Hg,HR分別為(99.2±11)次/min、(93.5±8)次/min、(83.3±6)次/min、(76.3±8)次/min,T3時,A、B、C、D四組患者M(jìn)AP分別為(105.6±11)mm Hg、(108.3±10)mm Hg、(88.2±7)mm Hg、(81.8±9)mm Hg,HR分別為(95.3±10)次/min、(83.4±7)次/min、(80.7±9)次/min、(74.3±10)次/min。與T0比較,A、B、C三組T1、T2、T3各時點(diǎn)MAP、HR均明顯增高,且明顯高于D組,差異均有統(tǒng)計(jì)學(xué)意義(P0.05);四組患者各時點(diǎn)的BIS值及Sp O2比較差異均無統(tǒng)計(jì)學(xué)意義(P0.05);A、B、C三組患者出現(xiàn)嗆咳例數(shù)分別為24例、20例、12例,發(fā)生率分別為80.000%、66.667%、40.000%,發(fā)生躁動分別為19例、13例、6例,發(fā)生率分別為63.333%、43.333%、20.000%,而D組患者均未發(fā)生,與D組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論胸科手術(shù)患者雙腔支氣管導(dǎo)管拔管時更換喉罩通氣過渡后拔管可以減輕全麻蘇醒拔管期血流動力學(xué)波動,降低蘇醒期不良反應(yīng),使患者麻醉蘇醒過程更加安全舒適。
[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 鹵81.2mm 鹵81.2mm Hgtrop, 78.2 鹵12mm 鹵12Omm Hgtrop, 75.2 鹵5mm, 74.3 鹵6min, 73.8 鹵8min, 74.8 鹵94.8min / min, 74.8 鹵94.8mm / min, 114.3 鹵61mm / 103.2 鹵92.2 鹵92mm / 10mm / h / h, respectively, respectively, and the MAP of the fourth group was 114.3 鹵610mm / h / g ~ 103.2 鹵92.2 鹵92.2 鹵10mm / 10mm / h / h / h, respectively, respectively, = 97.3 鹵87.3 鹵82.4 / 10mm / 6min) / 6min 鹵6min / 6h / r = 92.4 鹵6min / 6mg / r = 92.2 鹵92.2 鹵92.2 鹵10mm / 10mm / h / h, respectively. The MAP of the four groups were 114.3 鹵61mm / 103.2 鹵92.2 鹵92.2 鹵92.2 鹵10mm / 10mm / h and 97.3 鹵87.3 鹵87.3 鹵82.4 / 6min / 6min, respectively. The MAP of the four groups were 115.2 鹵13.3 鹵108.3mm 鹵108.2mm 鹵90.2mm 鹵12mm respectively, and 83.8 鹵12mm (99.2 鹵12mm) / min (93.5 鹵83.5 鹵83.53 鹵6min), respectively. The MAP of the four groups were 105.6 鹵11.3 鹵11mm Hgtrop, 108.3 鹵108.2mm 鹵98.2mm 鹵93.4mm 鹵83.4 鹵8min, respectively, and the MAP of the four groups were significantly higher than that of the control group (105.6 鹵11mm Hg / g = 108.3mm 鹵98.2mm 鹵93.4 鹵8min / 8min), respectively. The MAP of the four groups was significantly higher than that of the control group (P / min = 74.3 鹵118.2mm 鹵108.2mm 鹵98.2mm 鹵93.3t 鹵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 鹵13.3 鹵108.3 鹵108.3 鹵108.2mm 鹵98.2mm 鹵98.2mm 鹵93.4t 鹵8min, respectively). The mean MAP of the four groups was significantly higher than that of the control group (P < 0.05 鹵83.3 鹵6p / min, P / min = 73.3 鹵6t = 76.3 鹵86.3T 3, respectively). The MAP of the four groups was 105.6 鹵11.3 mm 鹵108.2mm 鹵108.2mm 鹵98.2mm 鹵98.2mm 鹵93.4 鹵8min 鹵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.
【作者單位】： 廈門市第二醫(yī)院麻醉科;
【分類號】：R614

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