CAJ | 학술논문

目的：探讨依托咪酯全麻患者肌松监测下气管拔管和传统气管拔管效果的差异。方法选取2014年1月~2015年1月广东省梅州市人民医院收治的120例行全麻择期手术患者作为研究对象，采用随机数字表法将其分为研究组和对照组，各60例。研究组患者在术中和术后进行肌松监测并决定术后拔管，对照组患者采取传统经验评估决定术后拔管，分别监护并记录两组患者在拔管后30 min的平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)及肌松残余值变化情况，并比较两组拔管期间麻醉剂残余效应室浓度(CE)、气管拔管时间(麻醉剂停注到通气导管拔出时间)、麻醉起效时间、意识恢复时间、拔管期间呛咳反应及各种不良反应反生率。结果研究组和对照组患者CE比较差异有统计学意义(P<0.05)；研究组高血压、低氧血症及心跳异常发生率、肌松残余率显著低于对照组，差异均有统计学意义(均P<0.05)；研究组呛咳反应程度明显低于对照组，差异有统计学意义(P<0.05)；研究组患者意识恢复时间短于对照组，差异有统计学意义(P<0.05)。结论肌松监测下气管拔管可有效降低拔管后患者不良反应及术后肌松残余发生率，安全性高，值得临床广泛推广。
목적：탐토의탁미지전마환자기송감측하기관발관화전통기관발관효과적차이。방법선취2014년1월~2015년1월광동성매주시인민의원수치적120례행전마택기수술환자작위연구대상，채용수궤수자표법장기분위연구조화대조조，각60례。연구조환자재술중화술후진행기송감측병결정술후발관，대조조환자채취전통경험평고결정술후발관，분별감호병기록량조환자재발관후30 min적평균동맥압(MAP)、심솔(HR)、혈양포화도(SpO2)급기송잔여치변화정황，병비교량조발관기간마취제잔여효응실농도(CE)、기관발관시간(마취제정주도통기도관발출시간)、마취기효시간、의식회복시간、발관기간창해반응급각충불량반응반생솔。결과연구조화대조조환자CE비교차이유통계학의의(P<0.05)；연구조고혈압、저양혈증급심도이상발생솔、기송잔여솔현저저우대조조，차이균유통계학의의(균P<0.05)；연구조창해반응정도명현저우대조조，차이유통계학의의(P<0.05)；연구조환자의식회복시간단우대조조，차이유통계학의의(P<0.05)。결론기송감측하기관발관가유효강저발관후환자불량반응급술후기송잔여발생솔，안전성고，치득림상엄범추엄。
Objective To investigate the effect differences between neuromuscular monitoring and conventional tracheal extubation in patients taken Etomidate for general anesthesia. Methods One hundred and twenty patients, who were taken general anesthesia for elective surgery in Meizhou People's Hospital from January 2014 to January 2015 were selected and randomly divided into the research group and the control group, each contained 60 cases. The research group were taken tracheal extubation decided by outcome of neuromuscular monitoring during and after operation, and the control group were taken tracheal extubation decided by traditional experience of assessment. The mean arterial pressure (MAP), heart rate (HR), oxygen saturation (SpO2) and muscle relaxation of residual value changes of the two groups were monitored and recorded respectively after extubation for 30 min. Then residual effect-site concentration (CE), extubation time (the time from the stop of anesthetic injection to ventilation extubation), onset time, consciousness recovery time, cough reflex during extubation and incidence of adverse reactions of the two groups were compared. Results The CE between the research group and the control group had statistically significant difference (P<0.05);the ratios of hypertension and hyoxemia, abnormal heartbeat and the ratio of postoperative residual curarizationmuscle in the research group were significantly lower than those in the control group, the differences were all statistically significant (P < 0.05); the cough reflex level between the research group and the control group had statistically significant difference (P<0.05); the consciousness recovery time of research group was shorter than that of the control group, the difference was statistically significant (P<0.05). Conclusion Neuromuscular monitoring tracheal extubation can effectively reduce the adverse reactions after extubation and the ratio of postoperative residual curarizationmuscle, which is safe and worthy of being promoted widely in clinic.