鼻咽通气道在神经外科患者麻醉恢复期的应用  

The Application of Nasopharyngeal Airway in Nurosurgery Patients during Anesthesia Recovery

作　　者：罗林丽[1] 周良学[2] 陈立君[2] 吕胜[1] 黄蔚[1] 罗东[1] 

机构地区：[1]四川大学华西第二医院麻醉科妇女疾病与出生缺陷教育部重点实验室,成都610041 [2]四川大学华西医院神经外科,成都610041

出　　处：《四川大学学报（医学版）》2013年第4期689-692,共4页Journal of Sichuan University(Medical Sciences)

基　　金：四川省科技厅科技支撑计划项目(No.2010GZ0293)资助

摘　　要：目的观察神经外科患者全麻恢复期安置鼻咽通气道的安全性和有效性。方法择期神经外科全麻患者60例,年龄25～67岁,ASAⅡ-Ⅲ级,随机分为口咽通气道组(O组)和鼻咽通气道组(N组),每组30例。术毕呼吸恢复满意后深麻醉下拔除气管导管后,O组置入口咽通气道,N组置入鼻咽通气道。记录诱导前(T0)、安置通气道前(T1)、安置通气道后1min(T2)、5min(T3)的血压和心率,记录两组通气道安置一次成功率、通气道留置时间和各组在留置期间需要调整通气道位置的次数及呼吸和循环的变化情况。记录安置通气道过程中的不良反应及对两种通气道患者的耐受性评分。结果 N组的血压和心率在T1和T2时点均较T0有不同程度升高(P<0.05),在T2时点较T1升高(P<0.05)。T3时点与T1及T2比较下降(P<0.05)。组间比较,N组T2时点的BP和HR均较O组升高(P<0.05)。N组通气道留置时间长于O组〔(137.4±18.32)min vs.(64.2±8.25)min,P<0.05〕;调整通气道位置的次数N组少于O组(0.34±0.21vs.2.80±0.54)(P<0.05);其间血压和心率高出基础值15%的发生率O组高于N组(80.0%vs.46.7%)(P<0.01);脉搏氧饱和度低于95%的发生率O组高于N组(26.7%vs.6.7%)(P<0.05)。O组患者出现恶心、上呼吸道梗阻和苏醒期躁动的比例明显高于N组(P<0.05)。N组患者通气道的耐受性评分明显优于O组(P<0.05)。结论鼻咽通气道能较好的维持神经外科麻醉恢复期患者的上呼吸道通畅效果,同时具有循环影响小,耐受性好和并发症少的优点。Objective To evaluate safety and effectiveness of nasopharyngeal airway used for neurosurgery patients during the anesthesia recovery period. Methods A total of 60 patients （ASAI-II ）, aged between 25 to 67 years old, who were scheduled to undergo elective neurosurgery operation under general anesthesia, were randomly divided into the oropharyngeal airway group （group O） and the nasopharyngeal airway group （group N）, with 30 cases in each group. After respiratory recovery was satisfactory at the end of operation, endotracheal tube was extubated under deep anesthesia. Afterwards, oropharyngeal airway was intubated in group O, and nasopharyngeal airway was intubated in group N. BP and HR before induction （To）, before airway intubation （T1）, at 1 min （T2） and 5 rain （Ts） after airway intubation were recorded. Meanwhile, one-time success rate of airway intubation, the airway retention time, the times of airway regulation due to location change and the change of respiration and circulation in each groups during airway retention period were recorded. In addition, adverse reactions during airway retention period and tolerance scores of patients in both groups were recorded. Results BP and HR in group N at T1 and T2 increased significantly compared with To （P 〈 0. 05）, Compared with T1, BP and HR increased significantly at T2 in group N （P〈0.05）. Compared with T1 and T2, the same index reduced significantly at T3 （P 〈0.05）. BP and HR in group N were significantly higher than those in group O at T2 （P〈0.05）. Airway retention time in group N was significantly longer than that in group O [（137.4±18.32） min vs. （64.2±8.25） min,P〈 0.05]; the times of airway location regulation in group N was less than that in group O （0.34±0.21 vs. 2.80± 0.54） （P〈0.05）. During airway retention period the incidence of BP and HR exceeding the base value by 15% in group O was higher than that in group N （80.0 % vs. 46.7 % ） （P〈0.01）, and the incidence of SPO2 l

关 键 词：鼻咽通气道 口咽通气道 气道管理 神经外科麻醉 

分 类 号：R614[医药卫生—麻醉学]