弹性橡胶探条对ICU危重患者气管插管应激反应的影响  

Effect of gum elastic bougie on the stress response to endotracheal intubation in critically ill patients

作　　者：刘伟[1] 孙晓旭[1] Liu Wei;Sun Xiaoxu(Department of Intensive Care Unit,the Fifth People＇s Hospital in Shenyang,Shenyang 110023,China)

机构地区：[1]沈阳市第五人民医院重症医学科,110023

出　　处：《中国医师进修杂志》2018年第8期728-731,共4页Chinese Journal of Postgraduates of Medicine

摘　　要：目的比较弹性橡胶探条引导和喉镜对危重患者气管插管应激反应的影响。方法选取2015年1月至2017年12月ICU收治的需行经口气管插管患者110例，按随机数字表法分为弹性橡胶探条组和Macintosh喉镜组，每组55例。比较两组患者插管前（T0）、插管后1 min（T1）、3 min（T2）、5 min（T3）的平均动脉压（MAP）、心率（HR），并于T0、T2测定血浆去甲肾上腺素（NE）、肾上腺素（E）的水平。结果插管后两组MAP、HR、NE、E水平均高于插管前。T1、T2、T3各时间点弹性橡胶探条组MAP水平低于Macintosh喉镜组MAP水平[（101.5 ± 6.4）mmHg比（116.2 ± 17.8）mmHg、（92.1 ± 3.3）mmHg比（110.4 ± 9.7）mmHg、（84.4 ± 7.7）mmHg比（97.5 ± 6.4）mmHg，1 mmHg=0.133 kPa]，差异有统计学意义（P〈0.05）；T1时点弹性橡胶探条组患者HR低于Macintosh喉镜组[（95.4 ± 7.9）次/min比（112.7 ± 12.6）次/min]，差异有统计学意义（P〈0.05）。插管后弹性橡胶探条组NE、E水平低于Macintosh喉镜组[（161.28 ± 10.45）ng/L比（189.32 ± 11.56）ng/L、（105.04 ± 7.31）ng/L比（128.61 ± 3.68）ng/L]，差异有统计学意义（P〈0.05）。结论同喉镜常规气管插管操作相比，弹性橡胶探条能够减轻患者的应激反应，维持血流动力学稳定。Objective To compare the effect of gum elastic bougie and laryngoscope on the stress response to endotracheal intubation in critically ill patients.MethodsA total of 110 cases patients admitted to intensive care unit who needed intubaton from January 2015 to December 2017 were randomly divided into 2 groups： gum elastic bougie group （gum elastic bougie was used for intubation） and Macintosh laryngoscope group（laryngoscope intubation was performed） with 55 patients in each group. The mean arterial blood （MAP） and heart rate （HR） were recorded before intubation（T0）, 1 min after intubation （T1）, 3 min after intubation（T2） and 5 min after intubation（T3）. The concentration of norepinephrine（NE） and epinephrine（E） in the vein were measured at T0 and T2.ResultsThe levels of MAP, HR, NE and E were increased in both groups after intubation （P〈0.05）. At T1, T2 and T3, the levels of MAP in gum elastic bougie group [（101.5 ± 6.4）, （92.1 ± 3.3）, （84.4 ± 7.7） mmHg, 1 mmHg=0.133 kPa] were significantly lower than those in Macintosh laryngoscope groupgroup [（116.2 ± 17.8）, （110.4 ± 9.7）, （97.5 ± 6.4） mmHg]（P〈0.05）. The level of HR in gum elastic bougie group at T1 [（95.4 ± 7.9） times/min] was significantly reduced than that in Macintosh laryngoscope group [（112.7 ± 12.6） times/min]（P〈0.05）. After intubation, the concentration of NE and E in gum elastic bougie group [（161.28 ± 10.45）, （105.04 ± 7.31） ng/L] were reduced than those in Macintosh laryngoscope group [（189.32 ± 11.56）, （128.61 ± 3.68） ng/L], there were significant differences between two groups （P〈0.05）.ConclusionsCompared with normal laryngoscope, gum elastic bougie guided intubation is of great significance in terms of better hemodynamics and less stress response.

关 键 词：气管插管 应激反应 弹性橡胶探条 

分 类 号：R614[医药卫生—麻醉学]