喉罩替换气管导管在开颅手术苏醒期中的应用研究(1)
摘 要：目的 比較开颅手术患者在苏醒期将气管导管替换成喉罩与未替换患者的血流动力学变化程度及呛咳次数，以探究将气管导管替换成喉罩是否有利于脑外科患者更加平稳安全的复苏。方法 选择我院2016年9月～2018年2月全麻下行颅骨切开手术的患者60例，随机分为A组和B组，每组30例。A组行常规气管插管，B组在手术结束后替换成喉罩。比较两组患者各时间点的SAP、HR、MAP、MCA流速、rSO2，以及血浆去甲肾上腺素含量、发生呛咳反应例数和降压药使用情况。结果 与术前T0相比，手术结束和拔管期间SAP、MAP、HR均升高(P<0.05)；拔管期间，A组在T2、T3、T4时间点的SAP、MAP、HR均高于B组，差异有统计学意义(P<0.05)。与术前T0相比，两组患者手术后MCA流速和rSO2在苏醒时均升高(P<0.05)；拔管期间，A组在T2、T3、T4时间点MCA流速和rSO2的升高均高于B组，差异有统计学意义(P<0.05)。两组患者血浆去甲肾上腺素含量在苏醒期均高于基础水平(P<0.05)，在T4时间点B组升高的程度小于A组(P<0.05)。A组发生呛咳反应例数高于B组，差异有统计学意义(P<0.05)。A组使用降压药例数高于B组，差异有统计学意义(P<0.05)。结论 在脑外科手术后更换双腔喉罩，可以维持更稳定的血流动力学，减少脑充血，同时减少全麻苏醒后的咳嗽发生率。
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关键词：喉罩；脑外科手术；苏醒；血流动力学
中图分类号：R614.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.23.025
文章编号：1006-1959(2018)23-0091-05
Abstract：Objective To compare the degree of hemodynamic changes and the number of coughs in patients with craniotomy who were replaced with laryngeal masks and unreplaced patients during the recovery period to find out whether replacing the tracheal tube with a laryngeal mask is beneficial to patients with brain surgery. A smooth and safe recovery. Methods 60 patients with general anesthesia underwent craniotomy from September 2016 to February 2018 in our hospital were randomly divided into group A and group B， with 30 cases in each group. Group A was routinely intubated， and group B was replaced with a laryngeal mask at the end of the procedure. SAP， HR， MAP， MCA flow rate， rSO2， plasma norepinephrine content， cough response and antihypertensive drug use were compared between the two groups.Results Compared with preoperative T0， SAP， MAP and HR were increased during the end of operation and extubation (P<0.05). During extubation， SAP， MAP and HR were higher in group A at T2， T3 and T4 higher than group B， the difference was statistically significant(P<0.05). Compared with preoperative T0， both MCA flow rate and rSO2 increased after surgery(P<0.05). During extubation， group A had increased MCA flow rate and rSO2 at T2， T3 and T4. higher than group B， the difference was statistically significant(P<0.05). The plasma norepinephrine levels in the two groups were higher than the basal level during the recovery period (P<0.05)，the degree of elevation in group B was less than that in group A at time T4 (P<0.05). The number of cough reaction in group A was higher than that in group B， and the difference was statistically significant (P<0.05). The number of antihypertensive drugs in group A was higher than that in group B， and the difference was statistically significant(P<0.05). Conclusion Replacement of the double-chamber laryngeal mask after brain surgery can maintain more stable hemodynamics， reduce cerebral congestion， and reduce the incidence of cough after general anesthesia., 百拇医药(马兴对 吴靓 姬宁宁)
, http://www.100md.com
关键词：喉罩；脑外科手术；苏醒；血流动力学
中图分类号：R614.2 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.23.025
文章编号：1006-1959(2018)23-0091-05
Abstract：Objective To compare the degree of hemodynamic changes and the number of coughs in patients with craniotomy who were replaced with laryngeal masks and unreplaced patients during the recovery period to find out whether replacing the tracheal tube with a laryngeal mask is beneficial to patients with brain surgery. A smooth and safe recovery. Methods 60 patients with general anesthesia underwent craniotomy from September 2016 to February 2018 in our hospital were randomly divided into group A and group B， with 30 cases in each group. Group A was routinely intubated， and group B was replaced with a laryngeal mask at the end of the procedure. SAP， HR， MAP， MCA flow rate， rSO2， plasma norepinephrine content， cough response and antihypertensive drug use were compared between the two groups.Results Compared with preoperative T0， SAP， MAP and HR were increased during the end of operation and extubation (P<0.05). During extubation， SAP， MAP and HR were higher in group A at T2， T3 and T4 higher than group B， the difference was statistically significant(P<0.05). Compared with preoperative T0， both MCA flow rate and rSO2 increased after surgery(P<0.05). During extubation， group A had increased MCA flow rate and rSO2 at T2， T3 and T4. higher than group B， the difference was statistically significant(P<0.05). The plasma norepinephrine levels in the two groups were higher than the basal level during the recovery period (P<0.05)，the degree of elevation in group B was less than that in group A at time T4 (P<0.05). The number of cough reaction in group A was higher than that in group B， and the difference was statistically significant (P<0.05). The number of antihypertensive drugs in group A was higher than that in group B， and the difference was statistically significant(P<0.05). Conclusion Replacement of the double-chamber laryngeal mask after brain surgery can maintain more stable hemodynamics， reduce cerebral congestion， and reduce the incidence of cough after general anesthesia., 百拇医药(马兴对 吴靓 姬宁宁)