摘要
目的探讨自制牙套在老年气管内插管全身麻醉中的效果和安全性。方法选择择期行腹腔镜胆囊切除术的老年患者100例,其中男64例,女36例,年龄65～95岁,体质量43～85kg,美国麻醉医师协会(ASA)分级Ⅱ级或Ⅲ级。采用随机、单盲的原则将患者分为牙套组(D组)和对照组(C组),每组50例。D组将牙套放入70℃的水中20秒,变软后放入口腔内上、下齿之间,20秒后取出放入冷水中定型待用。佩戴好牙套后开始诱导和插管,手术结束患者清醒拔管后取出牙套。C组麻醉诱导与D组相同,插管后用纱布缠绕牙垫以保护松动的牙齿。记录两组麻醉前(T0)、插管前(T1)、插管后(T2)、拔管前(T3)和拔管后(T4)收缩压(SBP)、舒张压(DBP)及心率(HR)的变化;记录气管插管所需时间;记录牙齿损伤或松动加重、脱落、牙龈出血、疼痛不适等并发症的发生情况,评价患者对麻醉的满意度。于T0、T2、T4时分别采集外周静脉血3mL,采用高效液相色谱法测定儿茶酚胺(以肾上腺素计)浓度。结果 2组患者不同时间点SBP、DBP、HR差异有统计学意义(P<0. 05),与T0比较,2组SBP、DBP、HR在T1、T2时均降低,差异有统计学意义(P <0. 05),C组SBP、HR在T3、T4时增加(P<0. 05);与C组比较,D组SBP、DBP、HR在T3、T4时均降低(P<0. 05),在插管时间上D组明显缩短(P<0. 05),D组牙齿损伤/松动加重、牙龈出血、口唇损伤及疼痛不适等并发症的发生率显著降低,差异有统计学意义(P<0. 05),D组患者满意度显著增加,差异有统计学意义(P<0. 01),在T4时血浆儿茶酚胺浓度明显降低,差异有统计学意义(P<0. 01)。结论自制牙套用于老年患者气管内插管全身麻醉中,减轻了牙齿或牙龈的损伤、疼痛和应激反应,可安全用于老年患者气管内插管操作时的口腔保护。
Objective To investigate the effect and safety of self-made dental pad in general anesthesia in elderly patients.Methods A total of 100elderly patients underwent laparoscopic cholecystectomy were selected,including 64males and 36females,aged 65-95years old,weighted 43-85Kg,The America Society of Anesthesiologists(ASA)grade II or III.Patients were divided into dental pad group(group D)and control group(C group),according to randomized and single-blind principle,with 50patients in each group.In group D,the dental pads were placed in hot water at 70℃for 20seconds,softened and placed between the upper and lower teeth of the mouth.After 20seconds,they were taken out and placed in cold water for setting.After wearing the dental pads,the anesthesia induction and intubation were started.The dental pads were remove after the patients revived and extubated.In group C,anesthesia induction was the same as in group D.Gauze was wrapped around the pad,after intubation,to protect the loose teeth.Recording systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)variation of pre-anesthesia(T0),pre-intubation(T1),post-intubation(T2),pre-extubation(T3)and post-extubation(T4).Recording intubation time,occurrences of complications such as tooth damage or loosening,tooth loose,gums bleeding,pain and discomfort.Patients satisfaction to the anesthesia were evaluated.At T0,T2,T4,3ml of peripheral venous blood was collected,and the concentration of catecholamine(as adrenaline)was determined by high performance liquid chromatography.Results There were differences in SBP,DBP and HR between the two groups at different time points(P<0.05).SBP,DBP and HR at T1and T2decreased in both groups compared with T0(P<0.05).SBP and HR at T3and T4increased in group C(P<0.05).Compared with group C,SBP,DBP and HR at T3and T4in group D decreased(P<0.05),and intubation time in group C were significantly shorter(P<0.05).The incidence of complications such as tooth damage or loosening,gums bleeding,lip injury,pain and discomfort were significantly lower in group D(P<0.05or P<0.01).In group D the satisfaction level was significantly higher(P<0.01),and plasma catecholamine concentration in T4was significantly reduced(P<0.01).Conclusion The self-made dental pad used in general anesthesia for endotracheal intubation in elderly patients,which can reduce the damage of teeth or gums,pain and stress response,could be safely used for oral protection during intubation in elderly patients.
作者
刘英
张运琼
王中胜
刘志莲
杨燕
Liu Ying;Zhang Yunqiong;Wang Zhongsheng(Department of Anesthesiology,Luzhou TraditionalChinese Medicine Hospital,Luzhou,Sichuan 646000,China)
出处
《四川医学》
CAS
2019年第2期142-146,共5页
Sichuan Medical Journal
基金
泸州市卫计委课题(编号:2017指导类)
泸州市中医医院课题(编号:201707)
关键词
口腔防护器
自制
麻醉
全身
老年人
mouth protector
self-made
anesthesia
general
elderly
