气管导管套囊放气方式对患者拔管期应激反应的影响  

Effects of different methods of deflating tracheal tube cuff on stress response of patients during extubation

作　　者：秦福恩 杨旭 赵咪 杨淋 袁利邦 巩固 Qin Fu'en;Yang Xu;Zhao Mi;Yang Lin;Yuan Libang;Gong Gu(Department of Anesthesiology,General Hospital of Western Theater Command of PLA,Chengdu,Sichuan,610083,China)

机构地区：[1]西部战区总医院麻醉科,成都610083

出　　处：《西南国防医药》2020年第4期304-306,共3页Medical Journal of National Defending Forces in Southwest China

基　　金：四川省卫健委资助面上项目(18J159)。

摘　　要：目的比较两种气管导管套囊放气方式对择期行气管插管全身麻醉手术的患者拔管期应激反应的影响。方法选择医院择期行气管插管全身麻醉的患者129例,手术时间1~2 h,随机分为对照组(C组)和试验组(D组),其中9例因手术超时剔除,共计120例患者纳入本试验,C组60例,D组60例;评估患者达到拔管指征后,C组用注射器一次快速抽尽套囊气体后拔管,D组用1 ml注射器分次缓慢抽尽气体后拔管,记录两组患者拔管期呛咳反射的程度;记录在松套囊前(T0)、拔管即刻(T1)、拔管后1 min(T2)、拔管后3 min(T3)、拔管后5 min(T4)、拔管后10 min(T5)患者的心率(HR)、平均动脉压(MAP)、心率收缩压乘积(RPP);记录术后30 min咽喉部不适及拔管记忆的情况。结果与C组比较,D组发生呛咳反射的程度明显降低(P <0.05)。与T0比较,两组患者T1、T2、T3、T4各时点的HR、MAP、RPP均明显升高(P <0.05)。D组患者T1、T2、T3、T4各时点的HR、MAP、RPP明显低于C组(P <0.05)。D组患者术后30 min咽喉部不适及拔管记忆的例数明显少于C组(P <0.05)。结论分次缓慢放松气管导管套囊可明显减轻全麻患者气管拔管期应激反应,血流动力学更加平稳,减轻其带来的咽喉部不适及不良记忆。Objective To explore the effects of two methods of tracheal tube cuff deflation on stress response during tracheal extubation of patients undergoing selective tracheal intubation procedure under general anesthesia. Methods A total of 129 patients who underwent selective tracheal intubation procedure under general anesthesia in our hospital were selected, and nine patients were excluded since their operation time exceeded the standard(1-2 h). At last, 120 patients were included in the experiment and divided into the control group(group C, n =60) and the experimental group(group D, n =60). When the patients were evaluated to have satisfied the extubation indicators, tracheal extubation was conducted for group C by using a syringe to rapidly deflate the tracheal tube cuff at one time, and tracheal extubation was conducted for group D by using a 1 ml syringe to slowly deflate the tracheal tube cuff at several times. The degree of cough response during extubation was recorded for both groups. The heart rate(HR), mean arterial pressure(MAP) and rate pressure product(RPP) of the patients before deflating the tracheal tube cuff(T0), immediately after extubation(T1), one minute after extubation(T2), three minutes after extubation(T3), five minutes after extubation(T4) and ten minutes after extubation(T5) were recorded. The incidence of postoperative sore throat and memory of tracheal extubation 30 minutes after the operation were recorded. Results The degree of cough response in group D was significantly lower than that of group C(P < 0.05).The HR, MAP, RPP at T1, T2, T3 and T4 were significantly increased compared to that at T0 in both groups(P < 0.05). The HR, MAP,RPP at T1, T2, T3 and T4 in group D were significantly lower than that in group C(P < 0.05). The number of cases that had postoperative sore throat and memory of tracheal extubation 30 minutes after the operation in group D was significantly less than that in group C(P < 0.05). Conclusion Deflating the tracheal tube cuff at several times can significantly atte

关 键 词：全身麻醉 气管插管 应激反应 气管拔管 套囊 

分 类 号：R614.2[医药卫生—麻醉学]