中国医药
中國醫藥
중국의약
CHINA MEDICINE
2011年
2期
193-195
,共3页
通气机,机械%臂丛%麻醉药,传导阻滞%上肢
通氣機,機械%臂叢%痳醉藥,傳導阻滯%上肢
통기궤,궤계%비총%마취약,전도조체%상지
Ventilators,mechanical%Brachial plexus%Anesthetics,local%Upper extremity
目的 探讨喉罩通气全身麻醉辅助臂丛神经阻滞在上肢手术中的应用.方法 择期行上肢骨折手术患者30例,完全随机分为2组,各15例:喉罩通气全麻辅助臂丛神经阻滞组(A组)和单纯喉罩通气全麻组(B组).A组先予1.6%利多卡因20～25 ml注入患侧肌间沟行臂丛神经阻滞.2组皆以芬太尼1μg/kg、异丙酚2.5 mg/kg诱导后置入喉罩.术中根据患者自主呼吸频率、心率和无创血压以及体动反应调整异氟醚吸人浓度.观察入室(T0)、诱导前(T1)、喉罩置入后3 min(T2)、切皮后1 min(T3)各时点心率、血压、血氧饱和度(SpO2)变化.比较术中潮气量、呼吸频率、呼气末二氧化碳分压(PETCO2)、异氟醚呼气末浓度(ET)、异氟醚最低肺泡有效浓度(MAC)及维持芬太尼用量.记录术后疼痛程度.结果 T2和T3时点A组潮气量[(443.83±52.98)和(450.25±53.92)ml]明显高于B组[(219.00±53.24)和(301.44±60.48)ml,均P＜0.01].T3时点A组呼吸频率值[(12.00±0.74)次/min]明显低于B组[(15.11±3.76)次/min,P＜0.01],A组PETCO2[(41.5±4.34)mm Hg]低于B组[(46.22±5.73)mm Hg(P＜0.05)].T2时点A组异氟醚ET[(1.04±0.37)%]和异氟醚MAC[(0.97±0.33)%]显著低于B组(1.53±0.21)%和(1.44±0.14)%(P＜0.01).T3时点A组异氟醚ET[(1.12±0.24)%]和异氟醚MAC[(0.98±0.21)%]低于B组[(1.29±0.15)%和(1.13±0.12)%,P＜0.05].A组术后镇痛优于B组(P＜0.01).B组拔罩时有3例躁动、1例反流.结论 喉罩通气全麻辅助臂丛神经阻滞在上肢手术麻醉中能有效降低术中吸入麻醉剂浓度,减少术后并发症发生.
目的 探討喉罩通氣全身痳醉輔助臂叢神經阻滯在上肢手術中的應用.方法 擇期行上肢骨摺手術患者30例,完全隨機分為2組,各15例:喉罩通氣全痳輔助臂叢神經阻滯組(A組)和單純喉罩通氣全痳組(B組).A組先予1.6%利多卡因20～25 ml註入患側肌間溝行臂叢神經阻滯.2組皆以芬太尼1μg/kg、異丙酚2.5 mg/kg誘導後置入喉罩.術中根據患者自主呼吸頻率、心率和無創血壓以及體動反應調整異氟醚吸人濃度.觀察入室(T0)、誘導前(T1)、喉罩置入後3 min(T2)、切皮後1 min(T3)各時點心率、血壓、血氧飽和度(SpO2)變化.比較術中潮氣量、呼吸頻率、呼氣末二氧化碳分壓(PETCO2)、異氟醚呼氣末濃度(ET)、異氟醚最低肺泡有效濃度(MAC)及維持芬太尼用量.記錄術後疼痛程度.結果 T2和T3時點A組潮氣量[(443.83±52.98)和(450.25±53.92)ml]明顯高于B組[(219.00±53.24)和(301.44±60.48)ml,均P＜0.01].T3時點A組呼吸頻率值[(12.00±0.74)次/min]明顯低于B組[(15.11±3.76)次/min,P＜0.01],A組PETCO2[(41.5±4.34)mm Hg]低于B組[(46.22±5.73)mm Hg(P＜0.05)].T2時點A組異氟醚ET[(1.04±0.37)%]和異氟醚MAC[(0.97±0.33)%]顯著低于B組(1.53±0.21)%和(1.44±0.14)%(P＜0.01).T3時點A組異氟醚ET[(1.12±0.24)%]和異氟醚MAC[(0.98±0.21)%]低于B組[(1.29±0.15)%和(1.13±0.12)%,P＜0.05].A組術後鎮痛優于B組(P＜0.01).B組拔罩時有3例躁動、1例反流.結論 喉罩通氣全痳輔助臂叢神經阻滯在上肢手術痳醉中能有效降低術中吸入痳醉劑濃度,減少術後併髮癥髮生.
목적 탐토후조통기전신마취보조비총신경조체재상지수술중적응용.방법 택기행상지골절수술환자30례,완전수궤분위2조,각15례:후조통기전마보조비총신경조체조(A조)화단순후조통기전마조(B조).A조선여1.6%리다잡인20～25 ml주입환측기간구행비총신경조체.2조개이분태니1μg/kg、이병분2.5 mg/kg유도후치입후조.술중근거환자자주호흡빈솔、심솔화무창혈압이급체동반응조정이불미흡인농도.관찰입실(T0)、유도전(T1)、후조치입후3 min(T2)、절피후1 min(T3)각시점심솔、혈압、혈양포화도(SpO2)변화.비교술중조기량、호흡빈솔、호기말이양화탄분압(PETCO2)、이불미호기말농도(ET)、이불미최저폐포유효농도(MAC)급유지분태니용량.기록술후동통정도.결과 T2화T3시점A조조기량[(443.83±52.98)화(450.25±53.92)ml]명현고우B조[(219.00±53.24)화(301.44±60.48)ml,균P＜0.01].T3시점A조호흡빈솔치[(12.00±0.74)차/min]명현저우B조[(15.11±3.76)차/min,P＜0.01],A조PETCO2[(41.5±4.34)mm Hg]저우B조[(46.22±5.73)mm Hg(P＜0.05)].T2시점A조이불미ET[(1.04±0.37)%]화이불미MAC[(0.97±0.33)%]현저저우B조(1.53±0.21)%화(1.44±0.14)%(P＜0.01).T3시점A조이불미ET[(1.12±0.24)%]화이불미MAC[(0.98±0.21)%]저우B조[(1.29±0.15)%화(1.13±0.12)%,P＜0.05].A조술후진통우우B조(P＜0.01).B조발조시유3례조동、1례반류.결론 후조통기전마보조비총신경조체재상지수술마취중능유효강저술중흡입마취제농도,감소술후병발증발생.
Objective To evaluate the advantage of laryngeal mask airway(LMA) inspiration anesthesia combined with brachial plexus blockage (BPB) in upper limb orthopaedic surgeries. Methods Thirty patients were divided randomly into two groups (n = 15). In group A,LMA combined with BPB was adopted,while LMA was used only in group B. In group A,a dosage of 20-25 ml 1.6% lydocaine was adopted in BPB before indution. Then LMA was inserted by 1 μg/kg fentanyl and 2.5 mg/kg propofol. Isoflurane inhaled concentration and fentanyl dose was adjusted according to the change of spontaneous respiratory rate (RR),heart rate (HR),noninvasive blood pressure (SBP,DBP)and moving. The changes of HR,SBP,DBP and pulse blood oxygen saturation(SpO2) were observed at four time points when patients went into the operation room(T0),before induction(T1),3 minutes after LMA insertion(T2) and 1 minute after skin incision(T3). Ttide volume(TV),RR,end-tidal carbon dioxide(PET CO2),expiratory concentration(ET) of isoflurane,minimum alveolar concentration(MAC) of isoflurane and fentanyl dose were compared between two groups. The ache degree was recorded after operations. Results At T2 and T3,TV in group A was higher than that in group B(P ＜ 0.01). At T3,RR in group A (12 ± 0.74) bpm was apparently lower than that in group B (15.11 ± 3.76) bpm (P ＜ 0.01). PET CO2 in group A (41.5 ± 4.34) mm Hg was lower than that in group B(46.22 ±5.73)mm Hg(P＜0.05). At T2,ET of isoflurane(1.04 ±0.37)% and MAC of isoflurane(0.97 ±0.33)% in group A were significantly lower than ET of isoflurane(1.53 ±0.21)% and MAC of isoflurane(1.44 ± 0.14)% in group B(P ＜ 0.01). At T3,ET of isoflurane(1.12 ± 0.24) % and MAC of isoflurane (0.98 ± 0.21) % in group A were lower than ET of isoflurane (1.29 ± 0.15)% and MAC of isoflurane(1.13 ±0.12)% in group B (P ＜ 0.05). Conclusion LMA combined with BPB can effectively degrade the anesthetic gases inhalation consistency during operations and reduce the incidence rate of postoperative complications.
