心脏手术后选择性早期拔管临床经验  

Clinical experience on selective extubation early after open heart surgery

作　　者：方才[1] 杨晏芳[1] 秦红[1] 

机构地区：[1]安徽省立医院麻醉科

出　　处：《中华麻醉学杂志》1997年第3期174-176,共3页Chinese Journal of Anesthesiology

摘　　要：目的：评估芬太尼、安氟醚静吸复合麻醉下体外循环（ＣＰＢ）心脏手术后选择性早期拔除气管导管的可能性。方法：随机对７８例ＣＰＢ心脏手术患者（男／女：４２／３６，体重：１１～６５ｋｇ、年龄３～５２岁，ＡＳＡⅡ～Ⅲ级）有关资料进行分析。结果：（１）术后平均拔管时间为２．５５±１．３８小时（０．５～６．０小时）。其中１３例（１６．７％）术毕即清醒拔管；１５例（１９．２％）术后予以适当地辅助呼吸后拔管；５０例（６４．１％）术后经短期（１．０～２．５小时）支持性机械呼吸（ＭＶ）后拔管；（２）所有患者拔管前循环功能稳定，自主呼吸正常并均经Ｔ形管供氧３０～６０分过程；（３）拔管后舌下坠３例，轻度支气管痉挛２例，咽喉疼痛３例。结论：对术前ＡＳＡⅡ～Ⅲ级的心脏手术患者，术后可选择性早期拔除气管导管。Objective:To evaluate the possibility of selective removal of endotracheal tube early after open heart surgery. Method:The data about 78 patients (M/F:42/36, body weight 11 65kg,age 3 25yr, ASA grade Ⅱ Ⅲ) recieving cardiac surgeries with CPB under fentanyl enflurance anesthesia were analysed. Results: ①The mean time of extubation after surgery was 2.55±1.38h(0.5 6.0h),13 cases (16.7%)waked up and extubated at end of operation,15 cases(19.2%)extubated after a proper assistant respiration was given and 50 cases(64.1%) received a short term (1.0 2.5h)mechanical ventilation(MV) before removing endotracheal tube. ② All patients had hemodynamic steadility and normal spontanous breath as well as a course of oxygen inspiration by T type piece before extubation. ③The complications following extubation included tongue swallowing (3 cases),slight bronchospasm(2 cases) and sore throat(3 cases). Conclusion:The selective extubation early after heart operation with CPB under fentanyl enflurance anesthesia is safe for those patients with preoperative ASA grade Ⅱ Ⅲ.

关 键 词：芬太尼 安氟醚 拔管 体外循环 心脏手术 

分 类 号：R654.2[医药卫生—外科学] R971.2[医药卫生—临床医学]