国际医药卫生导报
國際醫藥衛生導報
국제의약위생도보
INTERNATIONAL MEDICINE & HEALTH GUIDANCE NEWS
2010年
19期
2334-2337
,共4页
纪钦泉%谢朝峰%胡钦擎%张晓佳%陈响奇%王学林
紀欽泉%謝朝峰%鬍欽擎%張曉佳%陳響奇%王學林
기흠천%사조봉%호흠경%장효가%진향기%왕학림
声门 Yamamoto 分级法%支撑喉镜声带手术%心血管反应
聲門 Yamamoto 分級法%支撐喉鏡聲帶手術%心血管反應
성문 Yamamoto 분급법%지탱후경성대수술%심혈관반응
Glottic Yamamoto classification%Suspension laryngoscopy%Vocal cord surgery%Cardiovascular response
目的 研究支撑喉镜下声带手术的心血管反应与声门Yamamoto分级法的相关性.方法 回顾本院自2000年1月-2009年12月以来,静脉全麻下在显微镜支撑喉镜下行声带息肉手术的成年患者,排除高血压和冠心病,ASA Ⅰ~Ⅱ级的201例患者,按直接喉镜下声门的Yamamoto分级法分为1、2、3、4级,相对应分为A、B、C、D组.记录不同分组的患者的手术时间、麻醉诱导前基础值(T1)、诱导后5min(T2)、气管插管后即刻(T3)、置人支撑喉镜后5 min(T4)、10 min(T5)、15 min(T6)、20 min(T7)、拔出支撑喉镜后5 min(T8)的平均动脉压和心率的变化.结果 声门显露为4级的D组3例患者因无法完成手术而不计入本研究.C组的手术时间比A、B组延长(P<0.05),A、B组的手术时间无差异.3组麻醉诱导后血压和心率明显下降(P<0.01).A组放置支撑喉镜后血压和心率变化无统计学意义,B组的T7比T1明显增加(P<0.05),C组的T4、T5、T6、T7比T1显著增加(P<0.01),且比A、B组的血压和心率显著增加(P<0.01),取出支撑喉镜后,3组的血压T8和T1无差异(P>0.05),而B、C组的心率T8比T1明显增快(P<0.05).结论 声门Yamamoto分级法与支撑喉镜下声带手术的心血管反应有较好的正相关性,3级患者要注意预防不良的心血管反应.
目的 研究支撐喉鏡下聲帶手術的心血管反應與聲門Yamamoto分級法的相關性.方法 迴顧本院自2000年1月-2009年12月以來,靜脈全痳下在顯微鏡支撐喉鏡下行聲帶息肉手術的成年患者,排除高血壓和冠心病,ASA Ⅰ~Ⅱ級的201例患者,按直接喉鏡下聲門的Yamamoto分級法分為1、2、3、4級,相對應分為A、B、C、D組.記錄不同分組的患者的手術時間、痳醉誘導前基礎值(T1)、誘導後5min(T2)、氣管插管後即刻(T3)、置人支撐喉鏡後5 min(T4)、10 min(T5)、15 min(T6)、20 min(T7)、拔齣支撐喉鏡後5 min(T8)的平均動脈壓和心率的變化.結果 聲門顯露為4級的D組3例患者因無法完成手術而不計入本研究.C組的手術時間比A、B組延長(P<0.05),A、B組的手術時間無差異.3組痳醉誘導後血壓和心率明顯下降(P<0.01).A組放置支撐喉鏡後血壓和心率變化無統計學意義,B組的T7比T1明顯增加(P<0.05),C組的T4、T5、T6、T7比T1顯著增加(P<0.01),且比A、B組的血壓和心率顯著增加(P<0.01),取齣支撐喉鏡後,3組的血壓T8和T1無差異(P>0.05),而B、C組的心率T8比T1明顯增快(P<0.05).結論 聲門Yamamoto分級法與支撐喉鏡下聲帶手術的心血管反應有較好的正相關性,3級患者要註意預防不良的心血管反應.
목적 연구지탱후경하성대수술적심혈관반응여성문Yamamoto분급법적상관성.방법 회고본원자2000년1월-2009년12월이래,정맥전마하재현미경지탱후경하행성대식육수술적성년환자,배제고혈압화관심병,ASA Ⅰ~Ⅱ급적201례환자,안직접후경하성문적Yamamoto분급법분위1、2、3、4급,상대응분위A、B、C、D조.기록불동분조적환자적수술시간、마취유도전기출치(T1)、유도후5min(T2)、기관삽관후즉각(T3)、치인지탱후경후5 min(T4)、10 min(T5)、15 min(T6)、20 min(T7)、발출지탱후경후5 min(T8)적평균동맥압화심솔적변화.결과 성문현로위4급적D조3례환자인무법완성수술이불계입본연구.C조적수술시간비A、B조연장(P<0.05),A、B조적수술시간무차이.3조마취유도후혈압화심솔명현하강(P<0.01).A조방치지탱후경후혈압화심솔변화무통계학의의,B조적T7비T1명현증가(P<0.05),C조적T4、T5、T6、T7비T1현저증가(P<0.01),차비A、B조적혈압화심솔현저증가(P<0.01),취출지탱후경후,3조적혈압T8화T1무차이(P>0.05),이B、C조적심솔T8비T1명현증쾌(P<0.05).결론 성문Yamamoto분급법여지탱후경하성대수술적심혈관반응유교호적정상관성,3급환자요주의예방불량적심혈관반응.
Objective To explore the association of glottic Yamamoto classification and cardiovascular response during suspension laryngoscopic surgery for vocal cord polyps. Methods The data on 201 ASA Ⅰ~Ⅱ adult patients who had no existing coronary heart disease and hypertension and had undergone suspension microlaryngoscopic surgery for vocal cord polyps between January 2000 and December 2009 in our hospital were analyzed. The patients were assigned to group A, B, C, or D based on corresponding grade 1,2, 3 or 4 on the glottic Yamamoto classification. The changes in MAP and HR were noted at different time points: before anesthesia induction (T1), 5min after anesthesia induction (T2),completion of tracheal intubation (T3), 5min (T4), 10min (T5), 15min, (T6), and 20min (T7)after laryngoscopic insertion, and 5min after laryngoscopic extraction (T8). Results 3 patients in group D excluded in this study because of failure of the surgery. The surgical duration was longer in group C than in groups A and B (P<0.05) but did not differ between group A and group B. MAP and HR were decreased obviously in groups A, B, and C (P<0.01). MAP and HR did not change significantly in group A after laryngoscopic insertion. T7 was markedly longer than T1 in group B (P<0.05). T4, T5,T6, and T7 obviously longer than T1 in group C (P< 0.01). MAP and HR were obviously greater in group C than in groups A and B (P<0.01). MAP did not differ between T8 and T1 in all the groups (P>0.05); while HR at T8 was obviously greater than that at T1 in groups B and C (P<0.05). Conclusions Glottic Yamamoto classification is positively related with cardiovascular response during suspension laryngoscopic surgery for vocal cord polyps. We should pay attention to the prevention of adverse cardiovascular response in grade 3 patients.