高原地区手术患者全身麻醉的临床处理  

Clinical management on general anesthesia in surgical patients in plateau area

作　　者：马宏伟[1] 丁丽景[1] 周艳杰[1] 赵子军[1] 丁会峰[2] 罗珍 Ma Hongwei;Ding Lijing;Zhou Yanjie;Zhao Zijun;Ding Huifeng;Luo Zhen(Department of Anesthesiology, Hebei Provincial Chest Hospital, Shijiazhuang 050041, China)

机构地区：[1]河北省胸科医院麻醉科,石家庄050041 [2]河北省医学情报研究所院办 [3]西藏自治区阿里地区人民医院麻醉科

出　　处：《山西医药杂志》2019年第3期279-283,共5页Shanxi Medical Journal

基　　金：河北省医学科学研究重点课题计划(20170416)

摘　　要：目的探讨高原地区患者手术全身麻醉管理方法,评价其应用效果。方法对我院2013年7月至2016年7月全身麻醉下手术的76例高原患者,采用随机数字表法分为对照组和观察组,每组患者38例,比较2组患者入室时(T0)、气管插管后(T1)、切皮后30 min(T2)、拔管后30 min(T3)血压(BP)、心率(HR)、脉搏血氧饱和度(SpO_2)及血气指标[p H值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO2)、碱剩余(BE)、血氧饱和度(SaO2)],记录患者术中出入量及术中发生肺水肿及苏醒延迟的例数。结果术中血流动力学观察组比对照组波动小;观察组比对照组的血气指标得到纠正较快,观察组比对照组输液量少,并发症发生率低;观察组苏醒延迟的发生率也低于对照组,差异有统计学意义(P<0.05)。结论肺保护通气策略,目标导向液体管理患者呼吸循环指标,可确保高原地区全身麻醉手术患者安全度过围手术期。Objective To discuss the clinical management on general anesthesia in surgical patients in plateau area and to evaluate its application effects. Methods Seventy-six patients inplateau-area under general anesthesia in our hospital from July 2013 to July 2016 were selected and randomly divided into control group and observation group, with 38 cases in each group. BP, HR, SpO2 and blood gas values were compared between the groups at the time of patients entering the room, after tracheal intubation,30 minutes after skin incision and 30 minutes after tube drawing. Intake and output volume, occurrences of pulmonary edema and delayed recovery were recorded afterwards.Results Hemodynamic fluctuations were found smaller in observation group and the abnormal blood gas values were corrected more quickly in this group as well. Furthermore, less fluid infusion, lower rates of complication and delayed recovery were also noted in the observation group. Difference between the two groups was statistically significant(P<0.05). Conclusion Using lung protective ventilation strategy and target-oriented liquid infusion management to regulate respiratory and circulatory indexes can ensure the patients undergoing general anesthesia in plateau area safe in perioperative period.

关 键 词：高原地区 缺氧 手术 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]