中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2015年
32期
2616-2619
,共4页
励春颖%卢波%孟波%范晓翔%吴国荣%张燕%陈骏萍%祝胜美
勵春穎%盧波%孟波%範曉翔%吳國榮%張燕%陳駿萍%祝勝美
려춘영%로파%맹파%범효상%오국영%장연%진준평%축성미
胃窦面积%胃进气%罗库溴铵%超声检查
胃竇麵積%胃進氣%囉庫溴銨%超聲檢查
위두면적%위진기%라고추안%초성검사
Antral area%Gastric insufflation%Rocuronium%Ultrasonography
目的 使用超声实时监测胃窦进气情况,观察罗库溴铵对面罩通气时胃内进气的影响.方法 选取2014年6至10月宁波市第二医院接受择期喉罩全麻患者80例.年龄18～65岁,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,体质指数(BMI)＜ 30 kg/m2.随机分为2组(n=40):罗库溴铵组(R组)和无肌松对照组(C组).患者以丙泊酚、瑞芬太尼麻醉诱导,R组予罗库溴铵,C组予等量生理盐水,随后以压力控制模式[气道压力15 cmH2O(1 cmH2O =0.098 kPa)]行面罩通气,同时超声实时观察患者胃窦部进气情况.记录通气前后胃窦面积大小和通气前后胃窦面积差值大小、胃窦有无进气、面罩通气期间各项呼吸参数.结果 与面罩通气前相比,R组和C组面罩通气后胃窦面积分别为(579.5±167.3)、(508.1±112.2)mm2,高于通气前的(479.4±110.2)、(451.2±103.4)mm2,差异有统计学意义(t=5.938、4.302,均P＜0.001);根据胃内有无进气将2组患者进一步分为R+、R-、C+、C-4个亚组,R+、C+组面罩通气后胃窦面积分别为(647.7±150.6)、(546.2±121.1) mm2,高于通气前的(501.2± 113.6)、(422.6±101.5) mm2,差异有统计学意义(t =7.885、8.719,均P＜0.001),R-、C-组面罩通气后胃窦面积分别为(496.0±150.9)、(489.8±105.1) mm2,相比通气前的(452.9±102.8)、(465.0±103.3) mm2,差异无统计学意义(t=1.793、1.663,均P＞0.05);R+组通气前后胃窦面积差值为(146.6±87.2) mm2,大于R-组的(43.1±102.1)mm2;差异有统计学意义(t =3.458,P＜0.001),C+组通气前后胃窦面积差值为(123.6±51.1)mm2,大于C-组的(24.8±77.4) mm2,差异有统计学意义(t=4.172,P＜0.001);R+组和C+组相比,通气前后胃窦面积差值间的差异无统计学意义(t=0.983,P＞0.05).R组、C组胃内进气概率分别为55％(22/18)和32.5％ (13/27),差异有统计学意义(x2=4.114,P＜0.05).2组患者面罩通气期间实际测得气道峰压均与设定值相符.2组患者面罩通气期间各项呼吸参数比较差异无统计学意义.结论 罗库溴铵可能促进全麻患者15 cmH2O压力下行面罩通气所致的胃内进气.
目的 使用超聲實時鑑測胃竇進氣情況,觀察囉庫溴銨對麵罩通氣時胃內進氣的影響.方法 選取2014年6至10月寧波市第二醫院接受擇期喉罩全痳患者80例.年齡18～65歲,美國痳醉醫師協會(ASA)分級Ⅰ或Ⅱ級,體質指數(BMI)＜ 30 kg/m2.隨機分為2組(n=40):囉庫溴銨組(R組)和無肌鬆對照組(C組).患者以丙泊酚、瑞芬太尼痳醉誘導,R組予囉庫溴銨,C組予等量生理鹽水,隨後以壓力控製模式[氣道壓力15 cmH2O(1 cmH2O =0.098 kPa)]行麵罩通氣,同時超聲實時觀察患者胃竇部進氣情況.記錄通氣前後胃竇麵積大小和通氣前後胃竇麵積差值大小、胃竇有無進氣、麵罩通氣期間各項呼吸參數.結果 與麵罩通氣前相比,R組和C組麵罩通氣後胃竇麵積分彆為(579.5±167.3)、(508.1±112.2)mm2,高于通氣前的(479.4±110.2)、(451.2±103.4)mm2,差異有統計學意義(t=5.938、4.302,均P＜0.001);根據胃內有無進氣將2組患者進一步分為R+、R-、C+、C-4箇亞組,R+、C+組麵罩通氣後胃竇麵積分彆為(647.7±150.6)、(546.2±121.1) mm2,高于通氣前的(501.2± 113.6)、(422.6±101.5) mm2,差異有統計學意義(t =7.885、8.719,均P＜0.001),R-、C-組麵罩通氣後胃竇麵積分彆為(496.0±150.9)、(489.8±105.1) mm2,相比通氣前的(452.9±102.8)、(465.0±103.3) mm2,差異無統計學意義(t=1.793、1.663,均P＞0.05);R+組通氣前後胃竇麵積差值為(146.6±87.2) mm2,大于R-組的(43.1±102.1)mm2;差異有統計學意義(t =3.458,P＜0.001),C+組通氣前後胃竇麵積差值為(123.6±51.1)mm2,大于C-組的(24.8±77.4) mm2,差異有統計學意義(t=4.172,P＜0.001);R+組和C+組相比,通氣前後胃竇麵積差值間的差異無統計學意義(t=0.983,P＞0.05).R組、C組胃內進氣概率分彆為55％(22/18)和32.5％ (13/27),差異有統計學意義(x2=4.114,P＜0.05).2組患者麵罩通氣期間實際測得氣道峰壓均與設定值相符.2組患者麵罩通氣期間各項呼吸參數比較差異無統計學意義.結論 囉庫溴銨可能促進全痳患者15 cmH2O壓力下行麵罩通氣所緻的胃內進氣.
목적 사용초성실시감측위두진기정황,관찰라고추안대면조통기시위내진기적영향.방법 선취2014년6지10월저파시제이의원접수택기후조전마환자80례.년령18～65세,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급,체질지수(BMI)＜ 30 kg/m2.수궤분위2조(n=40):라고추안조(R조)화무기송대조조(C조).환자이병박분、서분태니마취유도,R조여라고추안,C조여등량생리염수,수후이압력공제모식[기도압력15 cmH2O(1 cmH2O =0.098 kPa)]행면조통기,동시초성실시관찰환자위두부진기정황.기록통기전후위두면적대소화통기전후위두면적차치대소、위두유무진기、면조통기기간각항호흡삼수.결과 여면조통기전상비,R조화C조면조통기후위두면적분별위(579.5±167.3)、(508.1±112.2)mm2,고우통기전적(479.4±110.2)、(451.2±103.4)mm2,차이유통계학의의(t=5.938、4.302,균P＜0.001);근거위내유무진기장2조환자진일보분위R+、R-、C+、C-4개아조,R+、C+조면조통기후위두면적분별위(647.7±150.6)、(546.2±121.1) mm2,고우통기전적(501.2± 113.6)、(422.6±101.5) mm2,차이유통계학의의(t =7.885、8.719,균P＜0.001),R-、C-조면조통기후위두면적분별위(496.0±150.9)、(489.8±105.1) mm2,상비통기전적(452.9±102.8)、(465.0±103.3) mm2,차이무통계학의의(t=1.793、1.663,균P＞0.05);R+조통기전후위두면적차치위(146.6±87.2) mm2,대우R-조적(43.1±102.1)mm2;차이유통계학의의(t =3.458,P＜0.001),C+조통기전후위두면적차치위(123.6±51.1)mm2,대우C-조적(24.8±77.4) mm2,차이유통계학의의(t=4.172,P＜0.001);R+조화C+조상비,통기전후위두면적차치간적차이무통계학의의(t=0.983,P＞0.05).R조、C조위내진기개솔분별위55％(22/18)화32.5％ (13/27),차이유통계학의의(x2=4.114,P＜0.05).2조환자면조통기기간실제측득기도봉압균여설정치상부.2조환자면조통기기간각항호흡삼수비교차이무통계학의의.결론 라고추안가능촉진전마환자15 cmH2O압력하행면조통기소치적위내진기.
Objective To explore the effect of rocuronium on gastric insufflation related to facemask ventilation in general anaesthesia patients.Methods Eighty patients from June to October 2015 undergoing elective operation under general anaesthesia at Ningbo NO.2 Hospital,ASA Ⅰ or Ⅱ grade,aged 18-65,were enrolled in this study and divided into two groups (n =40):Group R (rocuronium) and Group C (for control).Facemask pressure-controlled ventilation was started after general anaesthesia induced with propofol and remifentanil for a 2 min period while gastric insufflation was detected by ultrasonography of the antrum.The cross-sectional antral area(CSA) was measured using ultrasonography before and after facemask ventilation.Respiratory parameters were also recorded.Results Compared to the antral area before FMV,the CSA significantly increased in group R and C after FMV [post-FMV:(579.5 ± 167.3),(508.1 ± 112.2)mm2;pre-FMV(479.4 ± 110.2),(451.2 ± 103.4) mm2;t =5.938,4.302,P ＜0.001].All the patients were divided into four subgroups according to the gastric insufflation (R +,R-,C +,C-) and there were significant increases in the values of CSA before and after FMV in groups R + and C + [post-FMV (647.7 ± 150.6),(546.2 ± 121.1) mm2;pre-FMV (501.2 ± 113.6),(422.6 ± 101.5) mm2;t =7.885,8.719,P ＜0.001],without any significant increase in groups R-and C-[post-FMV(496.0 ± 150.9),(489.8 ± 105.1) mm2;pre-FMV (452.9 ± 102.8),(465.0 ± 103.3) mm2;t =1.793,1.663,P ＞ 0.05].Compared with the group R-,the CSA of group R + significantly increased before and after FMV [group R+(146.6±87.2) mm2;group R-(43.1 ±102.1)mm2;t=3.458,P＜0.001];compared with the group C-,the CSA of group C + significantly increased before and after FMV [group C + (123.6 ± 51.1) mm2;group C-(24.8 ± 77.4) mm2;t =4.172,P ＜ 0.001];there was no significant difference between the difference value of CSA in groups R + and C + before and after FMV (t =0.983,P ＞ 0.05).The incidence of gastric insufflation was 55％ and 32.5％ in group R and C,respectively(x2 =4.114,P ＜ 0.05).There was no significant difference in respiratory parameters between group R and C.Conclusion The study suggests that rocuronium may promote gastric insufflation related to facemask ventilation (15 cmH2O PCV)in general anaesthesia patients.
