中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE IN PRACTICE OF CRITICAL CARE MEDICINE
2014年
5期
372-375
,共4页
张红松%冯芳%董晨明%牟成华%宋瑞霞%杨朝辉
張紅鬆%馮芳%董晨明%牟成華%宋瑞霞%楊朝輝
장홍송%풍방%동신명%모성화%송서하%양조휘
重型颅脑损伤%留置胃管%应激反应
重型顱腦損傷%留置胃管%應激反應
중형로뇌손상%류치위관%응격반응
Severe craniocerebral injury%Indwelling gastric tube%Stress response
目的：观察纤维支气管镜（纤支镜）辅助下留置胃管和传统置管方式对重症监护病房（ICU）重型颅脑损伤患者应激反应的影响。方法将兰州大学第二医院外科ICU收住的126例重型颅脑损伤患者按随机数字表法分为纤支镜辅助留置胃管组（试验组）和传统方式留置胃管组（对照组），每组63例。试验组采用镜杆涂有利多卡因凝胶的奥林巴斯BF-P60纤支镜经鼻进入，到达会厌后调整镜头进入食管10 cm，沿活检口置入导引钢丝，边退镜边缓慢继续推送导丝；纤支镜退出后将准备置入的胃管内外管壁用石蜡油充分润滑后，沿导丝缓慢推入到合适位置后退出导丝，注射空气，有气过水声后固定。对照组用传统方式置管。于置管前及置管后1、3、5 min时监测患者收缩压（SBP）、舒张压（DBP）、心率（HR）、呼气末二氧化碳分压（PETCO2）及血浆去甲肾上腺素（NE）、肾上腺素、血管紧张素Ⅱ（AngⅡ）、血糖的变化。结果两组置管前SBP、DBP、HR、PETCO2、肾上腺素、NE、AngⅡ、血糖比较差异均无统计学意义（均P＞0.05）。试验组置管后各时间点SBP、DBP、HR、PETCO2、NE、肾上腺素、AngⅡ、血糖水平与置管前比较差异均无统计学意义（均P＞0.05），对照组置管后各时间点SBP、DBP、HR、NE、肾上腺素、AngⅡ、血糖水平均较置管前明显升高，PETCO2较置管前明显降低，试验组和对照组上述指标于置管后1 min比较差异即有统计学意义〔SBP（mmHg，1 mmHg＝0.133 kPa）：125.1±15.4比135.5±13.6，DBP（mmHg）：85.6±16.1比91.1±17.2，HR（次/min）：99.4±13.8比107.9±16.5，PETCO2（mmHg）：32.5±2.8比29.8±4.1，NE（ng/L）：365.4±29.7比475.7±49.9，肾上腺素（ng/L）：75.4±7.2比83.6±7.4， AngⅡ（ng/L）：65.3±6.9比73.3±9.1，血糖（mmol/L）：10.1±1.9比13.4±3.0，均P＜0.05〕，至置管后5 min试验组和对照组间各指标差异仍有统计学意义〔SBP（mmHg）：123.7±14.8比129.7±15.1，DBP（mmHg）：84.3±14.6比88.4±14.2，HR（次/min）：97.7±13.6比31.6±3.9，PETCO2（mmHg）：33.5±3.1比31.6±3.9， NE（ng/L）：363.9±31.3比457.7±48.4，肾上腺素（ng/L）：74.6±7.8比83.5±8.5，AngⅡ（ng/L）：64.3±8.4比71.9±5.9，血糖（mmol/L）：9.6±2.3比12.7±3.1，均P＜0.05〕。结论与传统方式比较，纤支镜辅助下留置胃管引起的应激反应轻。
目的：觀察纖維支氣管鏡（纖支鏡）輔助下留置胃管和傳統置管方式對重癥鑑護病房（ICU）重型顱腦損傷患者應激反應的影響。方法將蘭州大學第二醫院外科ICU收住的126例重型顱腦損傷患者按隨機數字錶法分為纖支鏡輔助留置胃管組（試驗組）和傳統方式留置胃管組（對照組），每組63例。試驗組採用鏡桿塗有利多卡因凝膠的奧林巴斯BF-P60纖支鏡經鼻進入，到達會厭後調整鏡頭進入食管10 cm，沿活檢口置入導引鋼絲，邊退鏡邊緩慢繼續推送導絲；纖支鏡退齣後將準備置入的胃管內外管壁用石蠟油充分潤滑後，沿導絲緩慢推入到閤適位置後退齣導絲，註射空氣，有氣過水聲後固定。對照組用傳統方式置管。于置管前及置管後1、3、5 min時鑑測患者收縮壓（SBP）、舒張壓（DBP）、心率（HR）、呼氣末二氧化碳分壓（PETCO2）及血漿去甲腎上腺素（NE）、腎上腺素、血管緊張素Ⅱ（AngⅡ）、血糖的變化。結果兩組置管前SBP、DBP、HR、PETCO2、腎上腺素、NE、AngⅡ、血糖比較差異均無統計學意義（均P＞0.05）。試驗組置管後各時間點SBP、DBP、HR、PETCO2、NE、腎上腺素、AngⅡ、血糖水平與置管前比較差異均無統計學意義（均P＞0.05），對照組置管後各時間點SBP、DBP、HR、NE、腎上腺素、AngⅡ、血糖水平均較置管前明顯升高，PETCO2較置管前明顯降低，試驗組和對照組上述指標于置管後1 min比較差異即有統計學意義〔SBP（mmHg，1 mmHg＝0.133 kPa）：125.1±15.4比135.5±13.6，DBP（mmHg）：85.6±16.1比91.1±17.2，HR（次/min）：99.4±13.8比107.9±16.5，PETCO2（mmHg）：32.5±2.8比29.8±4.1，NE（ng/L）：365.4±29.7比475.7±49.9，腎上腺素（ng/L）：75.4±7.2比83.6±7.4， AngⅡ（ng/L）：65.3±6.9比73.3±9.1，血糖（mmol/L）：10.1±1.9比13.4±3.0，均P＜0.05〕，至置管後5 min試驗組和對照組間各指標差異仍有統計學意義〔SBP（mmHg）：123.7±14.8比129.7±15.1，DBP（mmHg）：84.3±14.6比88.4±14.2，HR（次/min）：97.7±13.6比31.6±3.9，PETCO2（mmHg）：33.5±3.1比31.6±3.9， NE（ng/L）：363.9±31.3比457.7±48.4，腎上腺素（ng/L）：74.6±7.8比83.5±8.5，AngⅡ（ng/L）：64.3±8.4比71.9±5.9，血糖（mmol/L）：9.6±2.3比12.7±3.1，均P＜0.05〕。結論與傳統方式比較，纖支鏡輔助下留置胃管引起的應激反應輕。
목적：관찰섬유지기관경（섬지경）보조하류치위관화전통치관방식대중증감호병방（ICU）중형로뇌손상환자응격반응적영향。방법장란주대학제이의원외과ICU수주적126례중형로뇌손상환자안수궤수자표법분위섬지경보조류치위관조（시험조）화전통방식류치위관조（대조조），매조63례。시험조채용경간도유리다잡인응효적오림파사BF-P60섬지경경비진입，도체회염후조정경두진입식관10 cm，연활검구치입도인강사，변퇴경변완만계속추송도사；섬지경퇴출후장준비치입적위관내외관벽용석사유충분윤활후，연도사완만추입도합괄위치후퇴출도사，주사공기，유기과수성후고정。대조조용전통방식치관。우치관전급치관후1、3、5 min시감측환자수축압（SBP）、서장압（DBP）、심솔（HR）、호기말이양화탄분압（PETCO2）급혈장거갑신상선소（NE）、신상선소、혈관긴장소Ⅱ（AngⅡ）、혈당적변화。결과량조치관전SBP、DBP、HR、PETCO2、신상선소、NE、AngⅡ、혈당비교차이균무통계학의의（균P＞0.05）。시험조치관후각시간점SBP、DBP、HR、PETCO2、NE、신상선소、AngⅡ、혈당수평여치관전비교차이균무통계학의의（균P＞0.05），대조조치관후각시간점SBP、DBP、HR、NE、신상선소、AngⅡ、혈당수평균교치관전명현승고，PETCO2교치관전명현강저，시험조화대조조상술지표우치관후1 min비교차이즉유통계학의의〔SBP（mmHg，1 mmHg＝0.133 kPa）：125.1±15.4비135.5±13.6，DBP（mmHg）：85.6±16.1비91.1±17.2，HR（차/min）：99.4±13.8비107.9±16.5，PETCO2（mmHg）：32.5±2.8비29.8±4.1，NE（ng/L）：365.4±29.7비475.7±49.9，신상선소（ng/L）：75.4±7.2비83.6±7.4， AngⅡ（ng/L）：65.3±6.9비73.3±9.1，혈당（mmol/L）：10.1±1.9비13.4±3.0，균P＜0.05〕，지치관후5 min시험조화대조조간각지표차이잉유통계학의의〔SBP（mmHg）：123.7±14.8비129.7±15.1，DBP（mmHg）：84.3±14.6비88.4±14.2，HR（차/min）：97.7±13.6비31.6±3.9，PETCO2（mmHg）：33.5±3.1비31.6±3.9， NE（ng/L）：363.9±31.3비457.7±48.4，신상선소（ng/L）：74.6±7.8비83.5±8.5，AngⅡ（ng/L）：64.3±8.4비71.9±5.9，혈당（mmol/L）：9.6±2.3비12.7±3.1，균P＜0.05〕。결론여전통방식비교，섬지경보조하류치위관인기적응격반응경。
ObjectiveTo observe the effect on stress response to indwelling gastric tube assisted by bronchofiberoscope and traditional way in patients with severe craniocerebral injury in intensive care unit(ICU). Methods 126 patients admitted in Department of Surgery ICU in Lanzhou University Second Hospital were randomly divided into bronchofiberoscope assisted indwelling gastric tube group(experimental group) and the traditional way of indwelling gastric tube group(control group), 63 cases in each group. In the experimental group, the rod of mirror, Olypus BF-P60, was coated with lidocaine gel, through the nasal cavity it was sent into interior, when arrived at epiglottis, the operator adjusted the mirror head and let it go into the esophagus(about 10 cm), then put a steel wire as a guide into a hole for biopsy, and simultaneously, as the operator pulled out the rod, the wire was continuously pushed slowly further inside; after the bronchofiberoscope was completely withdrawn, valelinum liquidum was used to ensure sufficient lubrication to the external and internal walls of the indwelling gastric tube ready to be sent into the stomach, afterwards the tube was slowly pushed along the guide wire to an appropriate location and then the wire was pulled out, the operator injected air, when he or she heard the gurgling sound as the gas passing water, fixed the tube. In the control group, the traditional way of indwelling gastric tube was applied. Before and after indwelling gastric tube for 1, 3, 5 minutes, the changes of systolic pressure(SBP),diastolic pressure(DBP),heart rate(HR), end-expiratory carbon dioxide partial pressure(PETCO2) and plasma concentrations of norepinephrine(NE), adrenaline, angiotensinⅡ(AngⅡ), glucose(GLU) were examined.Results The plasma levels of SBP, DBP, HR, PETCO2, adrenaline, NE, AngⅡ and blood GLU had no statistical significant differences before operation in comparisons between both groups(allP>0.05). Compared to those before indwelling the tube, the levels of SBP, DBP, HR, PETCO2, NE, adrenaline, AngⅡ and GLU at various time points after the indwelling in experimental group were of no statisticalsignificant differences(allP>0.05), while the levels of SBP, DBP,HR, adrenaline, NE, AngⅡand GLU in control group at various time points after indwelling were higher obviously than those before operation, and the level of PETCO2 was decreased significantly compared with that before operation. The differences in the above indexes were significant between the treatment and control groups at 1 minute after indwelling〔SBP(mmHg, 1 mmHg=0.133 kPa): 125.1±15.4 vs. 135.5±13.6, DBP(mmHg): 85.6±16.1 vs. 91.1±17.2, HR(bpm): 99.4±13.8 vs. 107.9±16.5, PETCO2(mmHg): 32.5±2.8 vs. 29.8±4.1, NE(ng/L): 365.4±29.7 vs. 475.7±49.9, adrenaline(ng/L): 75.4±7.2 vs. 83.6±7.4, AngⅡ(ng/L): 65.3±6.9 vs. 73.3±9.1, GLU(mmol/L): 10.1±1.9 vs. 13.4±3.0, allP<0.05〕; the differences in the above indexes remained significant between the treatment and control groups till 5 minutes after indwelling〔SBP(mmHg): 123.7±14.8 vs. 129.7±15.1, DBP(mmHg): 84.3±14.6 vs. 88.4±14.2, HR(bpm): 97.7±13.6 vs. 31.6±3.9, PETCO2(mmHg): 33.5±3.1 vs. 31.6±3.9, NE(ng/L): 363.9±31.3 vs. 457.7±48.4, adrenaline(ng/L): 74.6±7.8 vs. 83.5±8.5, AngⅡ(ng/L): 64.3±8.4 vs. 71.9±5.9, GLU(mmol/L): 9.6±2.3 vs. 12.7±3.1, allP<0.05〕.ConclusionCompared with traditional way, the indwelling of gastric tube assisted by branchofiberoscopy can induce milder stress response.
