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单腔和双腔经口气管插管对患者血流动力学和唤醒水平影响的比较性研究 被引量:3

Comparison of hemodynamic and arousal responses to single-lumen endotracheal and doublelumen endobronchial intubation
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摘要 目的:比较单腔和双腔气管导管经口气管插管对患者血流动力学和唤醒水平的影响。方法:选取ASAⅠ~Ⅱ级、年龄19~66岁拟在经口气管插管全身麻醉下施择期手术的普外科和胸外科患者60例作为研究对象,分为直接喉镜单腔气管插管组(S组,n=30)和双腔气管插管组(D组,n=30)。麻醉诱导后分别采用Macintosh直接喉镜实施经口气管插管操作,观察两组患者麻醉诱导前、后,气管插管时和气管插管后5 min内的血压(BP)、心率(HR)、二重指数(RPP)和脑电双频指数(BIS)的变化,并记录气管插管时间。结果:与S组相比,D组气管插管时间明显较长,差异具有统计学意义(P<0.05)。麻醉诱导后,两组患者的BP和RPP均较麻醉诱导前明显降低。与麻醉诱导后相比较,气管插管后两组患者的BP、HR和RPP明显升高。与麻醉诱导前相比较,S组患者BP明显降低,D组患者BP收缩压无明显改变,舒张压和平均动脉压明显升高,且持续时间约1 min。两组患者气管插管后的HR均明显升高,且HR增快持续约4 min。与S组相比较,气管插管后D组BP和RPP均明显升高,HR在气管插管后即刻明显升高,其后无明显差异;两组间BIS水平比较,差异无统计学意义(P>0.05)。与S组比较,观察期D组SBP大于基础值30%、HR大于基础值30%的发生率和RPP大于22 000的发生率明显较高,差异有统计学意义(P<0.05)。结论:与经口单腔气管插管比较,采用Macintosh直接喉镜实施双腔气管插管可引起更为剧烈的血流动力学反应和类似的唤醒反应。 Objective:To compare the hemodynamic and arousal responses to single-lumen endotracheal and double-lumen endobronchial intubation using a Macintosh direct laryngoscope.Methods:A total of 60 patients with ASA physical statusⅠ-Ⅱ,aged 19-66 years,scheduled for elective general and thoracic sugeries under general anesthesia requiring orotracheal intubation were allocated to either the S group(n=30)or the D group(n=30).After an intravenous anesthetic induction,the orotracheal intubation was performed using a MDLS,respectively.Invasive BP and HR were recorded before and after anesthetic induction,immediately after intubation and 5 minutes after intubation with 1-minute interval and the intubation time was also noted.Rate-pressure product(RPP)and bispectral index(BIS)were calculated.Results:After anesthetic induction,BP and RPP in the two groups decreased significantly compared to their preinduction values.As comparison with their postinduction values,the orotracheal intubation in the two groups caused significant increases in BPs,HR and RPP.In S group,as comparison with their preinduction values,BP decreased significantly.In D group,as comparison with their preinduction values,there was no significant difference in systolic pressure,the intubation caused significant increases in diastolic pressure and mean arterial pressure and lasted for 1 min.HR of both groups after intubation were significantly higher than their baseline values,and increase in HR lasted for 4 min.In D group,BPs and RPP were also significantly higher than S group;HR immediately after intubation was also significantly higher than S group.Except for this value,there was no significant difference in HR at any time point during the observation between the two groups.The value of BIS is similar between both groups.In D group,the incidences of SBP more than 130%of baseline value,HR more than 130%of baseline value and RPP more than 22 000 were significantly higher than S group.The intubation time in D group is longer than S group.Conclusion:As compared
作者 刘鲲鹏 李伟 崔晶 姚兰 LIU Kun-Peng;LI Wei;CUI Jin;YAO Lan(Department of Anesthesiology,Peking University International Hospital,Beijing 100029,China)
出处 《转化医学电子杂志》 2018年第1期23-27,共5页 E-Journal of Translational Medicine
关键词 单腔气管导管 双腔支气管导管 经口气管插管 血流动力学 single-lunmen endotracheal tube double-lunmen endobronchial tube orotracheal intubation hemodynamic responses
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