CAJ | 학술논문

目的：阐述介入手术中麻醉管理的重要性。方法回顾性分析2011年4月至2015年4月期间接受3、4级介入手术患者共24382例,根据术中麻醉方式分为静脉全身麻醉联合喉罩或气管插管机械通气组(A组)、静脉全身麻醉自主呼吸组(B组)、清醒镇静组(C组)、局部麻醉组(D组)。监测4组患者术前、术中、术后心率(HR)、平均动脉压(ABP)、血氧饱和度(SpO2)变化及麻醉相关并发症情况,并进行统计分析。结果24382例患者均按手术方案顺利实施麻醉,其中3级手术16702例(68.5％),4级手术7680例(31.5％)；3级手术中A组6797例(40.7％)、B组3608例(21.6％)、C组5095例(30.5％)、D组1202例(7.2％),4级手术中A组4193例(54.6％)、B组2527例(32.9％)、C组699例(9.1％)、D组261例(3.4％)。各组患者术前HR、ABP与SpO2差异无统计学意义(P＞0.05)。A、B、C组患者术中HR、ABP较术前差异无统计学意义(P＞0.05),组间比较差异无统计学意义(P＞0.05),SpO2无明显改变(P＞0.05)；D组患者术中HR、ABP较术前均有升高(P＜0.05),与其它3组比较存在统计学差异(P＜0.05),SpO2无明显改变(P＞0.05)。 D组中有22例患者因不能耐受而终止手术。结论在不同等级介入手术,尤其是3、4级介入手术中,针对患者不同病情和手术需要,选择个性化麻醉方案是手术安全、顺利、无干扰完成的重要保障,也是减少患者手术痛苦的良好途径,值得在介入手术中广泛推广应用。
목적：천술개입수술중마취관리적중요성。방법회고성분석2011년4월지2015년4월기간접수3、4급개입수술환자공24382례,근거술중마취방식분위정맥전신마취연합후조혹기관삽관궤계통기조(A조)、정맥전신마취자주호흡조(B조)、청성진정조(C조)、국부마취조(D조)。감측4조환자술전、술중、술후심솔(HR)、평균동맥압(ABP)、혈양포화도(SpO2)변화급마취상관병발증정황,병진행통계분석。결과24382례환자균안수술방안순리실시마취,기중3급수술16702례(68.5％),4급수술7680례(31.5％)；3급수술중A조6797례(40.7％)、B조3608례(21.6％)、C조5095례(30.5％)、D조1202례(7.2％),4급수술중A조4193례(54.6％)、B조2527례(32.9％)、C조699례(9.1％)、D조261례(3.4％)。각조환자술전HR、ABP여SpO2차이무통계학의의(P＞0.05)。A、B、C조환자술중HR、ABP교술전차이무통계학의의(P＞0.05),조간비교차이무통계학의의(P＞0.05),SpO2무명현개변(P＞0.05)；D조환자술중HR、ABP교술전균유승고(P＜0.05),여기타3조비교존재통계학차이(P＜0.05),SpO2무명현개변(P＞0.05)。 D조중유22례환자인불능내수이종지수술。결론재불동등급개입수술,우기시3、4급개입수술중,침대환자불동병정화수술수요,선택개성화마취방안시수술안전、순리、무간우완성적중요보장,야시감소환자수술통고적량호도경,치득재개입수술중엄범추엄응용。
Objective To describe the importance of anesthesia management in performing interventional procedures. Methods A total of 24 382 patients, who were admitted to authors’ hospital during the period from April 2011 to April 2015 to receive level Ⅲ or level Ⅳ interventional procedures, were enrolled in this study. According to the anesthesia method, the patients were divided into (1) mechanical ventilation group (group A), i.e. intravenous general anesthesia combined with laryngeal mask or endotracheal intubation, (2) intravenous general anesthesia and autonomous respiratory group (group B), (3) conscious sedation group (group C) and (4) local anesthesia group (group D). The heart rate (HR), mean arterial pressure (ABP), blood oxygen saturation (SpO2) and anesthesia-related complications of the patients of all four groups were kept under close observation before, during and after the interventional procedures, the results were statistically analyzed. Results The anesthesia was successfully implemented according to the operation plan in all 24 382 patients. Interventional procedure of level Ⅲ was performed in 16 702 patients(68.5%) and interventional procedure of levelⅣwas adopted in 7 680 patients (31.5%). The patients receiving interventional procedure of level Ⅲof group A, B, C and D were 6 797 (40.7%), 3 608 (21.6%), 5 095(30.5%) and 1 202(7.2%) respectively;while the patients receiving interventional procedure of level Ⅳ of group A, B, C and D were 4 193 (54.6%), 2 527 (32.9%), 699 (9.1%) and 261 (3.4%)respectively. No statistically significant differences in preoperative HR, ABP and SpO2 existed between each other among the four groups (P>0.05). In group A, B and C the HR and ABP values determined in operation were not statistically different from the preoperative ones(P>0.05), and the differences in HR and ABP values among the three groups were also not statistically different (P>0.05);SpO2 levels showed no obvious changes (P>0.05). In group D, the HR and ABP values determined in operation were significantly higher than the preoperative ones (P<0.05), and also these values were statistically different from those of other three groups (P<0.05);SpO2 levels showed no obvious changes (P>0.05). In 22 patients of group D the operation had to be stopped as they were unable to tolerate the procedure. Conclusion In performing different levels of interventional procedures, level Ⅲ and level Ⅳ intervention surgeries in particular, careful selection of individualized anesthesia plan on the base of patient’s condition and operation requirement is an important guarantee for ensuring a safe operation with no interference, and it is also a good way to reduce the pain severity of patient. Therefore, individualized anesthesia plan is worth to be widely used in interventional procedures.