本文選題：腹部超聲 + 胃體積��； 參考：《貴州醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討腹部超聲監(jiān)測下全身麻醉誘導(dǎo)期不同通氣方式前、后胃體積的改變,為飽胃患者實施全身麻醉誘導(dǎo)時選擇何種通氣方式提供一定臨床依據(jù)。方法:選擇2015年6月~11月我院70例ASA分級為:I~II級,年齡:20~60歲,身高:151~176cm,體重:40kg~65kg,Mallampati分級為Ⅰ~Ⅱ級,擬施行四肢骨科手術(shù)的非妊娠患者,分為七個組,每組均為10例,男、女不限,分別為:A1組、A2組、A3組、A4組以及B1組、B2組、B3組。其中,A組均為急診手術(shù)患者共40例:禁食禁飲時間均大于4h,小于8h,將其隨機分為A1組、A2組、A3組和A4組。A1組患者全身麻醉誘導(dǎo)時采用常規(guī)正壓通氣方式;A2組患者全身麻醉誘導(dǎo)期采用高頻率、低潮氣量通氣方式;A3組患者全身麻醉誘導(dǎo)期采用預(yù)充氧無正壓通氣方式;A4組患者全身麻醉誘導(dǎo)前均留置胃、腸減壓管并連接負壓引流瓶,其余處理措施均與A1組患者完全相同。B組為擇期手術(shù)患者共30例,禁食禁飲時間均大于8h,將其隨機分為:B1組、B2組、B3組。B1組、B2組、B3組全身麻醉誘導(dǎo)期通氣方式分別與A1組、A2組、A3組患者完全相同。施行全身麻醉前所有患者均由同一名醫(yī)生行腹部超聲檢查尋找胃竇,并測量其面積;全身麻醉行氣管插管后,由該醫(yī)生再次行腹部超聲檢查尋找胃竇并測量其面積。研究全過程中,全身麻醉誘導(dǎo)前或麻醉后,不能獲得良好切面者及氣管插管次數(shù)1次的病人被排除在外。運用相關(guān)公式通過胃竇面積換算出胃的體積,將全身麻醉誘導(dǎo)前胃體積標(biāo)記為V1;全身麻醉誘導(dǎo)氣管插管后的胃體積標(biāo)記為V2。結(jié)果:70例被納入研究的患者,氣管插管均為一次成功,每例患者均能獲得良好的胃竇切面,無患者發(fā)生反流、誤吸。各組內(nèi)麻醉誘導(dǎo)前、后胃體積比較:A1、A2、A4、B1、B2組V2與V1比較,差異具有統(tǒng)計學(xué)意義(P0.05),提示:V2明顯大于V1;A3、B3組V2與V1比較,差異無統(tǒng)計學(xué)意義(P0.05),提示:V2較V1無明顯變化。各組間V1的比較,差異無統(tǒng)計學(xué)意義;各組間V2的比較:A1、A2、A4、B1、B2組與A3、B3組間比較差異有統(tǒng)計學(xué)意義(P0.05),其余兩兩比較差異無統(tǒng)計學(xué)意義,提示:A1、A2、A4、B1、B2組V2值較A3、B3組大;7組間V2與V1差值比較:A1、A2、A4、B1、B2組與A3、B3組間比較差異有統(tǒng)計學(xué)意義(P0.05),其余兩兩比較差異無統(tǒng)計學(xué)意義,提示:A1、A2、A4、B1、B2組V2與V1差值較A3、B3組大;各組內(nèi)患者基礎(chǔ)SPO2與氣管插管成功時SPO2比較,差異無統(tǒng)計學(xué)意義(P0.05);各組間患者的基礎(chǔ)SPO2、氣管插管成功時的SPO2比較差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論:全身麻醉誘導(dǎo)期間,預(yù)充氧無正壓通氣的方式,對胃體積改變的影響最小。
[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.
【學(xué)位授予單位】：貴州醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R614.2

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