中国医药导刊
中國醫藥導刊
중국의약도간
CHINESE JOURNAL OF MEDICAL GUIDE
2014年
7期
1111-1112,1114
,共3页
纪存良%李天佐%孙永兴%郭玉良
紀存良%李天佐%孫永興%郭玉良
기존량%리천좌%손영흥%곽옥량
喉罩%眼底手术%自主呼吸
喉罩%眼底手術%自主呼吸
후조%안저수술%자주호흡
Laryngeal mask%Retinal surgery%Spontaneous Breathing
目的：观察眼底手术中全身麻醉保留自主呼吸的临床效果。方法：眼底手术患者260例，男172例，女88例，年龄18～79岁，平均(48±14)岁。分为气管插管控制呼吸组(A组)130例和喉罩保留自主呼吸组(B组）130例。A组患者给予丙泊酚、芬太尼、维库溴铵等药物，进行气管插管控制呼吸全身麻醉。B组给予维库溴铵、丙泊酚、盐酸右美托嘧啶、曲马多、氯化琥珀酰胆碱等药物置入可弯曲喉罩，保留自主呼吸全身麻醉，必要时(PETCO2＞50mmHg)行手控辅助呼吸。两组患者均给予球后神经阻滞并吸入2.5%～3.5%的七氟醚维持麻醉,术后包头和包头开始前10分钟停用七氟醚。记录麻醉期间相关时间点患者的血压，血氧饱合度，心率，呼吸等，观察术中血流动力学及呼吸参数，以及术后恢复质量、不良反应发生率等。结果：A组气管插管及拔管时血压及心率都有所升高，B组插管时及插管后15min内心率减慢，差异显著(P<0.05)。两组血氧无差异(P＞0.05)，PETCO2 B组较A组略高(P<0.05)；拔管时间及手术后的苏醒时间B组均优于A组(P<0.05)；围手术期出现并发症B组明显低于A组(P<0.05)。结论：成人眼底手术中全身麻醉保留自主呼吸能有效地降低围术期并发症的发生，患者苏醒快，恢复时间短，是安全可靠的。
目的：觀察眼底手術中全身痳醉保留自主呼吸的臨床效果。方法：眼底手術患者260例，男172例，女88例，年齡18～79歲，平均(48±14)歲。分為氣管插管控製呼吸組(A組)130例和喉罩保留自主呼吸組(B組）130例。A組患者給予丙泊酚、芬太尼、維庫溴銨等藥物，進行氣管插管控製呼吸全身痳醉。B組給予維庫溴銨、丙泊酚、鹽痠右美託嘧啶、麯馬多、氯化琥珀酰膽堿等藥物置入可彎麯喉罩，保留自主呼吸全身痳醉，必要時(PETCO2＞50mmHg)行手控輔助呼吸。兩組患者均給予毬後神經阻滯併吸入2.5%～3.5%的七氟醚維持痳醉,術後包頭和包頭開始前10分鐘停用七氟醚。記錄痳醉期間相關時間點患者的血壓，血氧飽閤度，心率，呼吸等，觀察術中血流動力學及呼吸參數，以及術後恢複質量、不良反應髮生率等。結果：A組氣管插管及拔管時血壓及心率都有所升高，B組插管時及插管後15min內心率減慢，差異顯著(P<0.05)。兩組血氧無差異(P＞0.05)，PETCO2 B組較A組略高(P<0.05)；拔管時間及手術後的囌醒時間B組均優于A組(P<0.05)；圍手術期齣現併髮癥B組明顯低于A組(P<0.05)。結論：成人眼底手術中全身痳醉保留自主呼吸能有效地降低圍術期併髮癥的髮生，患者囌醒快，恢複時間短，是安全可靠的。
목적：관찰안저수술중전신마취보류자주호흡적림상효과。방법：안저수술환자260례，남172례，녀88례，년령18～79세，평균(48±14)세。분위기관삽관공제호흡조(A조)130례화후조보류자주호흡조(B조）130례。A조환자급여병박분、분태니、유고추안등약물，진행기관삽관공제호흡전신마취。B조급여유고추안、병박분、염산우미탁밀정、곡마다、록화호박선담감등약물치입가만곡후조，보류자주호흡전신마취，필요시(PETCO2＞50mmHg)행수공보조호흡。량조환자균급여구후신경조체병흡입2.5%～3.5%적칠불미유지마취,술후포두화포두개시전10분종정용칠불미。기록마취기간상관시간점환자적혈압，혈양포합도，심솔，호흡등，관찰술중혈류동역학급호흡삼수，이급술후회복질량、불량반응발생솔등。결과：A조기관삽관급발관시혈압급심솔도유소승고，B조삽관시급삽관후15min내심솔감만，차이현저(P<0.05)。량조혈양무차이(P＞0.05)，PETCO2 B조교A조략고(P<0.05)；발관시간급수술후적소성시간B조균우우A조(P<0.05)；위수술기출현병발증B조명현저우A조(P<0.05)。결론：성인안저수술중전신마취보류자주호흡능유효지강저위술기병발증적발생，환자소성쾌，회복시간단，시안전가고적。
Objective: To observe clinical effects of spontaneous breathing reserved in retinal surgery under general anesthesia. Methods: Retinal surgery 260 cases, 172 cases of male, female 88 cases, aged 18 to 79 years, mean (48±14) years of age. Divided into control breathing intubation group (group A) and spontaneous respiration LMA group (group B). 130 cases of each. A group of patients given propofol, fentanyl and vecuronium drugs, controlled breathing intubation under general anesthesia. Group B received vecuronium, propofol, dexmedetomidine hydrochloride, tramadol ,succinylcholine chloride and lfexible LMA intubated during general anesthesia with spontaneous breathing, which be changed to manual ventilation if necessary(PETCO2>50mmHg). Two groups of patients were given retrobulbar nerve block and inhalation of 2.5%~3.5% sevolfurane, which deactivated in postoperative bandaging head or ten minutes before the bandaging. Patients' blood pressure, oxygen saturation, heart rate,respiration and so on were recorded at the relevant time points during anesthesia, the hemodynamic and respiratory parameters observed, as well as the quality of postoperative recovery, incidence of adverse reactions, etc.Results:Blood pressure and heart rate of group A elevated during endotracheal intubation and extubation while heart rate in group B slowed down while or 15min after intubation, the difference was significant (P<0.05). There's no significantly difference in two groups' oximetry(P>0.05), PETCO2 slightly higher in group B than that of group A(P<0.05);Group B was superior to group A as far as extubation time and recovery time after surgery was concerned(P<0.05); Perioperative complications in group B was signiifcantly lower than that in group A (P<0.05).Conclusions:Adult retinal surgery under general anesthesia with spontaneous breathing can effectively reduce the incidence of perioperative complications in patients with rapid recovery, recovery time is short, it is safe and reliable.
