膈肌超声对于食管癌患者术后拔管时机的评估研究  

Evaluation of diaphragmatic ultrasonography for postoperative extubation in patients with esophageal cancer

作　　者：陈刚 韩彬 CHEN Gang;HAN Bin(Department of Anesthesiology,First Affiliated Hospital of Xi′an Medical University/School of General Practice,Xi′an 710077,China)

机构地区：[1]西安医学院第一附属医院/西安医学院全科医学院麻醉科,西安710077

出　　处：《新疆医科大学学报》2023年第2期222-225,共4页Journal of Xinjiang Medical University

基　　金：陕西省社会发展科技攻关项目(2016SF-111)。

摘　　要：目的通过超声行膈肌厚度检查计算膈肌厚度变化率(Diaphragmatic thickness fraction,DTF)判断全麻术后患者拔管时机。方法纳入择期行胸腹腔镜联合食管癌手术患者78例,年龄30~75岁,ASA分级Ⅰ级~Ⅲ级。患者随机分为两组,两组患者麻醉诱导前及手术结束后拔管前行高频探头行超声检查,记录吸气末和呼气末膈肌厚度,得出膈肌厚度变化率(DTF)。但A组患者以DTF≥30%作为肌力恢复指标,B组以TOF值>90作为肌力恢复指标。比较两组的膈肌厚度变化率,拔管时间,拔管时Ramsay评分与呼吸频率,再次插管发生率,术后肺部并发症。结果A组膈肌厚度变化率(35.68%)与B组(42.46%)相比略低,差异无统计学意义(P>0.05)。A组再次插管例数1例,B组未出现再次插管病例。与B组相比,A组拔管时间明显缩短(13.5±4.3 vs 18.3±5.3,P=0.013),拔管时A组Ramsay评分与呼吸频率较B组相比差异无统计学意义(Ramsay:2.2±0.7 vs 2.5±0.5,P=0.391,RR:14.7±2.4 vs 15.4±2.8,P=0.443),两组术后肺部感染发生率无统计学差异(18.9%vs 13.2%,P=0.213)。结论超声测量膈肌厚度变化率≥30%可作为判断膈肌肌力恢复指标用于食管癌术后患者拔管时机的安全指标。ObjectiveTo evaluate the timing of extubation after general anesthesia by calculating the diaphragm thickness fraction(DTF)by ultrasound examination of diaphragm thickness.Methods78 patients with esophageal cancer who underwent elective thoracoscopic resection surgery for esophageal cancer were enrolled,aged 30-75 years,and ASA gradesⅠ-Ⅲ.The patients were randomly divided into two groups.Before induction of anesthesia and extubation,the patients in the two groups underwent ultrasonography with a high-frequency probe.The thickness of the diaphragm at the end of inspiration and end-expiration was recorded,and the diaphragm thickness fraction(DTF)was obtained.However,the patients in group A took DTF≥30%as the muscle strength recovery index,and group B took TOF value>90 as the muscle strength recovery index.The diaphragm thickness fraction,extubation time,Ramsay score and respiratory rate during extubation,the incidence of reintubation,and postoperative pulmonary complications were compared between the two groups.ResultsThe diaphragm thickness fraction in group A(35.68%)was slightly lower than that in group B(42.46%),but there was no statistical difference(P>0.05).There were 1 case of re-intubation in group A,and no case of re-intubation in group B.Compared with group B,the extubation time in group A was significantly shorter(13.5±4.3 vs 18.3±5.3,P=0.013),and there was no significant difference in Ramsay score and respiratory rate between group A and group B during extubation(Ramsay:2.2±0.7 vs 2.5±0.5,P=0.391,RR:14.7±2.4 vs 15.4±2.8,P=0.443),there was no significant difference in the incidence of postoperative pulmonary infection between the two groups(18.9%vs 13.2%,P=0.213).ConclusionUltrasound measurement of diaphragm thickness fraction≥30%can be used as a safety index for judging the recovery of diaphragm muscle strength in patients with esophageal cancer after surgery for extubation.

关 键 词：超声 食管癌 膈肌厚度变化率 肌松残余 

分 类 号：R444[医药卫生—诊断学]