侧卧位深度镇静下气管拔管对高血压手术患者心血管应激反应、上呼吸道并发症及心理状况的影响研究  

Effect of endotracheal extubation with deep sedation in lateral position on cardiovascular stress response,upper respiratory tract complications and psychological status in patients with hypertension surgery

作　　者：卢泽安[1] 曾文聪[1] 李晓明 纪浩聪[1] LU Zean;ZENG Wencong;LI Xiaoming;JI Haocong(Department of Anesthesiology,the First People's Hospital of Huizhou City,Huizhou,Guangdong 516003,China)

机构地区：[1]惠州市第一人民医院麻醉科,广东惠州516003

出　　处：《中国医学工程》2022年第12期83-87,共5页China Medical Engineering

基　　金：惠州市科技计划项目(200315224576601)。

摘　　要：目的探讨侧卧位深度镇静下气管拔管对老年高血压腹腔镜胆囊切除术(LC)治疗患者心血管应激反应、上呼吸道并发症及心理状况的影响。方法前瞻性选取2020年7月至2022年3月惠州市第一人民医院老年高血压择期行LC治疗患者100例为研究对象,采用随机数字表法将其分为侧卧组(n=50)和仰卧组(n=50)。两组均常规进行气管插管全身麻醉下择期LC治疗。侧卧组在侧卧位深度镇静下气管拔管,仰卧组在仰卧位深度镇静下气管拔管。比较两组麻醉诱导前(T_(0))、气管插管即刻(T_(1))、气管插管后5 min(T_(2))、拔除气管导管后1 min(T_(3))、拔除气管导管后5 min(T_(4))的平均动脉压(MAP)、心率(HR)、脉搏血氧饱和度(SpO_(2))等心血管应激反应指标。统计比较两组舌后坠发生率及喉痉挛、呛咳、咽部不适、声音嘶哑、肺炎等上呼吸道并发症发生率。采用Ricker镇静-躁动评分(SAS评分)评价比较两组拔除气管导管期间的躁动程度。术前1 d和麻醉苏醒后均采用焦虑自评量表评价比较两组患者的心理状况。结果与T_(0)比较,两组T_(3)和T_(4)的MAP和HR升高而同期SpO_(2)降低(P<0.05);且侧卧组T_(3)和T_(4)的MAP和HR低于仰卧组,同期SpO_(2)高于仰卧组(P<0.05)。侧卧组舌后坠发生率低于仰卧组(P<0.05);而两组上呼吸道并发症发生率比较,差异无统计学意义(P>0.05)。与术前1 d比较,两组麻醉苏醒后焦虑自评量表得分均降低(P<0.05);且侧卧组麻醉苏醒后焦虑自评量表得分低于仰卧组(P<0.05);侧卧组SAS评分低于仰卧组(P<0.05)。结论侧卧位深度镇静下气管拔管有利于减轻老年高血压择期LC患者心血管应激反应、麻醉苏醒期躁动和焦虑心理,并可减少舌后坠的发生。【Objective】To investigate the effect of tracheal extubation under deep sedation in lateral position on cardiovascular stress response,upper respiratory tract complications and psychological status in elderly hypertension patients undergoing laparoscopic cholecystectomy(LC)treatment.【Methods】A hundred elderly hypertensive patients undergoing LC treatment in our hospital from July 2020 to March 2022 were prospectively selected as the research objects.The patients were divided into lateral position group(n=50)and supine position group(n=50)by random number table method.Both groups were routinely treated with selective LC under general anesthesia with tracheal intubation.The lateral position group was extubated under deep sedation in the lateral position,and the supine position group was extubated under deep sedation in the supine position.Before induction of anesthesia(T_(0)),immediately after tracheal intubation(T_(1)),5 minutes after tracheal intubation(T_(2)),1 minutes after tracheal catheter removal(T_(3)),and 5 minutes after tracheal catheter removal(T_(4)),mean arterial pressure(MAP),heart rate(HR),pulse oximetry(SpO_(2))and other cardiovascular stress response indicators of the two groups were monitored and compared.The rate of posterior tongue drop and laryngospasm,coughing,pharyngeal discomfort,hoarseness,pneumonia and other upper respiratory tract complications between the two groups were statistically compared.The Ricker sedation-restlessness score(SAS score)was used to evaluate and compare the agitation of the two groups during the removal of the tracheal tube.Anxiety self-rating scale was used to evaluate and compare the psychological status of the two groups of patients 1 day before operation and after awakening from anesthesia.【Results】Compared with those of T_(0),the MAP and HR of T_(3) and T_(4) in the two groups increased while SpO_(2) in the two groups in the same period decreased(P<0.05);compared with those of the supine position group,the MAP and HR of T_(3) and T_(4) in the lateral

关 键 词：侧卧位 深度镇静 气管拔管 高血压 心血管应激反应 上呼吸道并发症 心理 

分 类 号：R614[医药卫生—麻醉学]