预适应张口呼吸对鼻部手术全麻患者的影响  

The effects of adaptive open-mouth breathing on patients undergoing general anesthesia for nasal surgery

作　　者：蒋涛 张悦 欧册华 JIANG Tao;ZHANG Yue;OU Ce-hua(a.Department of Pain Management,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Anesthesiology,The Affiliated Hospital of Southwest Medical University,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院麻醉科,四川泸州646000 [2]西南医科大学附属医院疼痛科,四川泸州646000

出　　处：《实用医院临床杂志》2023年第3期101-104,共4页Practical Journal of Clinical Medicine

基　　金：四川省自然科学基金资助项目(编号:2022NSFSC1479)。

摘　　要：目的探讨术前一天适应性张口呼吸对鼻内镜手术患者全麻后血流动力学、苏醒期躁动及术后舒适度的影响。方法纳入全麻下行鼻内镜手术患者100例。按随机数字法分为试验组和对照组各50例,试验组术前一天适应性张口呼吸2 h,术前再适应1 h;对照组不实施适应性张口呼吸。比较两组手术时间、术中出血量、术毕自主呼吸恢复时间、语言指令反应时间及拔除气管内导管时间,麻醉诱导前(T0)、插管即刻(T1)、术毕(T2)、拔除气管导管(T3)、出手术室(T4)、出PACU(T5)时刻的心率和血压、T3咳嗽评分,T3~T4恶心呕吐及疼痛评分。记录两组拔管后两分钟Riker镇静-躁动评分(SAS评分)及Ramsay镇静评分、PACU停留时间、术前和术后24 h Kolcaba的舒适状况及苏醒期躁动发生率。结果两组手术时间、术中出血量、术毕自主呼吸恢复时间、术毕语言指令反应时间、术毕拔除气管内导管时间、T0~T5时间点的心率和平均动脉压、T3咳嗽评分、T3~T4恶心呕吐及疼痛评分比较,差异无统计学意义(P>0.05)。试验组SAS评分和PACU停留时间低于对照组,Rasmay镇静评分、术后24 h Kolcaba评分高于对照组(P<0.05)。试验组EA发生率低于对照组(P<0.05)。结论术前适应性张口呼吸能有效减少鼻内镜手术患者全麻后苏醒期躁动的发生率,减少患者PACU停留时间,提高患者术后舒适度。Objective To investigate the effect of adaptive open-mouth breathing one day before surgery on hemodynamics,emergence agitation(EA)and postoperative comfort in patients who underwent nasal endoscopic surgery.Methods One hundred patients with nasal endoscopic operation under general anesthesia were included.The patients were randomly divided into an experimental group and a control group,50 in each group.The experimental group adapted to open-mouth breathing for 2 hours one day before the operation,and then adapted for 1 hour before the operation.The control group did not implement adaptive mouth breathing.The operation time,intraoperative blood loss,recovery time of spontaneous respiration after operation,response time of verbal instruction after operation,and removal time of endotracheal catheter were compared between the two groups.Heart rate and blood pressure before anesthesia induction(T0),immediately after intubation(T1),after surgery(T2),tracheal catheter removal(T3),out of the operating room(T4),out of PACU(T5),cough score at T3,nausea at T3-T4,and vomiting and pain score were also compared between the two groups.Riker sedation-agitation score(SAS score)and Ramsay sedation score,PACU residence time,preoperative and postoperative comfort of 24 hKolcaba as well as the incidence of restlessness during the recovery period were recorded in both groups.Results There were no significant differences in the operation time,intraoperative blood loss,recovery time of spontaneous respiration after operation,response time of verbal commands after operation,time of endotracheal catheter removal,heart rate and mean arterial pressure(MAP)at T0~T5 time point,cough score at T3,nausea at T3~T4 and vomiting score(P>0.05).The SAS score and PACU residence time in the experimental group were lower or shorter than those in the control group(P<0.05).Rasmay sedation score and 24 hKolcaba score after surgery in the experimental group were higher than those in the control group(P<0.05).The incidence of EA in the experimental group wa

关 键 词：麻醉 全身 苏醒期躁动 预适应 鼻内镜手术 

分 类 号：R765[医药卫生—耳鼻咽喉科] R614.2[医药卫生—临床医学]