摘要
目的观察达米弱刺激通气型口垫(达米口垫)作为一种创新型过渡性口咽通气道在麻醉苏醒期的安全性和有效性。方法选取行气管插管全身麻醉腹部手术且拔管后出现意识未完全恢复清醒、伴有舌后坠或呼吸不畅的患者200例,男153例,女47例,年龄26~66岁,体重42~91 kg,ASAⅠ—Ⅲ级。随机分为四组:达米口垫组(D组)、口咽通气道组(K组)、鼻咽通气管组(B组)和传统托颌组(C组),每组50例。拔管后气道管理措施:D组经口置入达米弱刺激通气型口垫;K组置入口咽通气道;B组经鼻置入鼻咽通气道;C组出现气道梗阻情况时予以托颌通气处理。记录拔除气管导管前即刻(T0)、拔管后5 min(T1)、拔管后10 min(T2)、拔管后15 min(T3)的血流动力学指标(HR、BP、SpO2)、血气分析指标(PaCO2、PaO2、pH值);记录通气道留置时间、调整通气道次数,以及PACU停留时间、拔管后通气过程中舒适度。记录不良反应的发生情况。结果与D组比较,T1时C组HR明显增快(P<0.05),T2时K组、C组HR明显增快(P<0.05),T3时K组HR明显增快(P<0.05),T2、T3时K组、B组MAP明显升高(P<0.05),T3时B组、C组PaCO2明显升高(P<0.05),T1—T3时K组、B组、C组PaO2明显降低(P<0.05),T2时C组、T3时B、C组pH值明显升高(P<0.05)。与T0时比较,T1时四组HR明显减慢,MAP明显降低(P<0.05),T2时D组HR减慢,D组、B组MAP明显降低(P<0.05),T3时K组、B组HR明显增快,MAP明显升高(P<0.05),T1—T3时四组PaO2、pH值明显降低,PaCO2明显升高(P<0.05)。四组不同时点SpO2差异无统计学意义。与D组比较,K组通气道留置时间和调整通气道次数明显增多(P<0.05),C组PACU停留时间明显延长(P<0.05),K组、C组拔管后舒适度明显降低(P<0.05)。C组躁动发生率明显升高(P<0.05)。结论达米弱刺激通气型口垫在气管插管全身麻醉恢复期能够有效维持呼吸道的通畅,具有循环影响小、舒适度高、不良反应小等优点,优于传统口咽、鼻咽通气道。
Objective To explore the clinical significance of Dami weakly stimulated oropharyngeal pad(Dami airway) as an innovative transitional airway in patients undergoing general anesthesia with endotracheal intubation. Methods A total of 200 patients, 153 males and 47 females, aged 26-66 years, weighing 42-91 kg, ASA physical status Ⅰ-Ⅲ, who underwent general anesthesia with endotracheal intubation and incomplete recovery of consciousness, falling back of tongue or poor breathing after extubation were selected. Randomly divided into four groups, 50 cases in each group: group D, group K, group B and group C. After extubation, airway management measures were as follows: in group D, the mouth pad with weak stimulation of Damiairway was put into the mouth;in group K, the mouth pharynx airway was put into the mouth;in group B, the nasopharynx airway was put into the nose;in group C, when airway obstruction occurred, the mouth pad was put into the mouth. The hemodynamic indexes(HR, BP, SpO2), blood gas analysis indexes(PaCO2, PaO2, pH value) were recorded immediately before extubation(T0), 5 minutes after extubation(T1), 10 minutes after extubation(T2), and 15 minutes after extubation(T3). The time of airway retention, the number of airway adjustment, the stay time of PACU, and the comfort score during the course of ventilation after extubation were recorded. The adverse reactions were recorded. ResultsCompared with group D, the HR of the patients in group C at T1 was higher(P<0.05), the HR of the patients in groups K and C at T2 was higher(P<0.05), the HR of the patients in group K at T3 was higher(P<0.05), the MAP of the patients in groups K and B at T2 and T3 was higher(P<0.05). Compared with T0, the HR of the patients in the four groups at T1 was lower(P<0.05), the HR of the patients in group D at T2 was lower(P<0.05), and those in groups in K and B at T3 was higher(P<0.05). Compared with T0, the MAP of the patients in the four groups at T1 was lower(P<0.05), the MAP of the patients in groups D and B at T2 was lower(P<0.05), and those in groups K and B at T3 was higher(P<0.05). Compared with the group D, the PaCO2 of the patients in groups B and C at T3 was higher(P<0.05), the PaO2 of the patients in groups K, B and C at T1, T2 and T3 was lower(P<0.05);the pH of the patients in group C at T2 was higher(P<0.05), the pH of the patients in groups B and C at T3 was higher(P<0.05). Compared with T0, the PaO2 and pH in four groups were lower at T1-T3(P<0.05), and the PaCO2 were higher(P<0.05). The PACU time of the patients in group C was longer than that in group D(P<0.05). The comfort level of the patients in group D was better than those in groups K and group C(P<0.05). Moreover, the incidence of restlessness in the group D was significantly lower than that in group C(P<0.05). Conclusion Dami weakly stimulated oropharyngeal pad can effectively manage patients’ airway, thus reducing adverse reactions and improving patients’ comfort, which has practical application value.
作者
夏敏
章蔚
陶磊
柴小青
疏树华
谢言虎
尤月同
张润卯
XIA Min;ZHANG Wei;TAO Lei;CHAI Xiaoqing;SHU Shuhua;XIE Yanhu;YOU Yuetong;ZHANG Runmao(Department of Anesthesiology,the First Affiliated Hospital of USTC,Division of Life Sciences and Medicine,University of Science and Technology of China,Hefei 230001,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第7期660-664,共5页
Journal of Clinical Anesthesiology
基金
吴阶平医学基金(320.6750.16166)。
关键词
口垫
全身麻醉
苏醒期
气道管理
Oropharyngeal pad
General anesthesia
Recovery period
Airway management
