早期拔除气管导管对肺癌患者全麻苏醒期复苏质量的影响  

Effect of Early Tracheal Extubation on the Quality of Resuscitation in Patients with Lung Cancer During Recovery from General Anesthesia

作　　者：邓小娥 张丽凤[1] 周春锋[1] 谢显龙[1] 黄莹 黎阳[1] 黄玲[1] Deng Xiaoe;Zhang Lifeng;Zhou Chunfeng(Intensive Care Unit,Affiliated Tumor Hospital of Guangxi Medical University,Nanning,Guangxi 530021,China)

机构地区：[1]广西医科大学附属肿瘤医院重症医学科,广西南宁530021

出　　处：《四川医学》2021年第5期433-437,共5页Sichuan Medical Journal

基　　金：广西壮族自治区卫生健康委员会自筹经费科研课题(编号:Z20190551)。

摘　　要：目的探讨早期拔除气管导管对肺癌患者全麻苏醒期质量的影响。方法选取我院2019年2月至2020年4月收治的100例择期全麻胸腔镜下肺癌根治术的患者,采用计算机随机分组法分成对照组和观察组,各50例。对照组术后按常规完全清醒拔管,观察组达到拔管指征后,在一定麻醉深度下早期拔管。记录患者入复苏室时(T0)、脱机时(T1)、拔管前5 min(T2)、拔管时(T3)、拔管后5 min(T4)、拔管后10 min(T5)、出复苏室时(T6)的生命体征,拔管后并发症发生率,出复苏室时点PaO_(2)、PaCO_(2)氧合指数的变化,拔管5 min后时点镇静评分(Ramsay);记录拔管时间、PACU滞留时间。结果观察组患者拔管前、后5 min血压和心率变化不大,拔管5~10 min后两者基本恢复到拔管前水平,对照组拔管前、后5 min血压和心率均显著上升,特别是拔管时上升幅度最大,两组比较,差异有统计学意义(P<0.05);观察组并发症发生率明显低于对照组(P<0.01);出复苏室时点PaO_(2)、PaCO_(2)氧合指数的比较差异无统计学意义(P>0.05);观察组拔管后5 min时点Ramsay评分、拔管和滞留PACU时间明显优于对照组(P<0.05)。结论肺癌患者术后早期拔除气管导管具有一定的安全性与可行性,可减少拔管应激和心血管反应、降低并发症发生率、缩短PACU时间,患者平稳度过麻醉苏醒期,提高复苏质量,对ERAS进一步的补充与完善提供科学依据。Objective To investigate the effect of early tracheal extubation on the quality of patients with lung cancer during recovery from general anesthesia.Methods From February 2019 to April 2020,100 patients with lung cancer underwent elective thoracoscopic radical resection.The patients were randomly divided into control group and observation group by the computer,50 cases in each group.In the control group,extubation was performed routinely when patients were completely awake.In the observation group,extubation was done when patients were in certain degree of anesthesia and their medical conditions achieved extubation criteria.The vital signs of patients were recorded at 7 time points,namely the time patients entering the recovery room(T0),the time the machine is off-line(T1),5 minutes before extubation(T2),the time of extubation(T3),5 minutes after extubation(T4),10 minutes after extubation(T5),the time patients leaving the recovery room(T6).In addition,complication rate after extubation,the change of PaO_(2)/PaCO_(2)/oxygenation index at T6,ramsay sedation scale at T4 and the PACU retention time were recorded.Results There were no significant changes in blood pressure and heart rate in the observation group before and 5 minutes after extubation.The blood pressure and heart rate basically returned to the level before extubation 5~10 minutes after extubation.The blood pressure and heart rate of the control group increased significantly 5 minutes before and after extubation.In particular,blood pressure and heart rate increased the most during extubation.The blood pressure and heart rate of the two groups were significantly different(P<0.05).The complication rate of the observation group was lower than that of control group(P<0.01).PaO_(2),PaCO_(2)and oxygenation index showed no significant difference between groups at T6(P>0.05).The Ramsay score,extubation time and retention time in PACU in the observation group at T4 were significantly better than those in the control group(P<0.05).Conclusions Early extubation after

关 键 词：肺癌患者 早期拔除气管导管 复苏期质量 

分 类 号：R734.2[医药卫生—肿瘤]