喉罩过渡联合帕瑞昔布钠术前给药对双腔气管导管拔管应激反应的影响-现代医学

喉罩过渡联合帕瑞昔布钠术前给药对双腔气管导管拔管应激反应的影响

单位：山东省菏泽市中医医院

分类号：

出版年·卷·期（页码）：2015·43·第五期（567-570）

摘要：

目的：探讨喉罩过渡联合帕瑞昔布钠术前给药对双腔气管导管拔管期应激反应的影响。方法：收集择期全麻下行胸腔镜手术的患者¹40例。随机分为喉罩过渡组、帕瑞昔布钠组、联合组和对照组，每组³5例。对照组患者在苏醒期直接拔除双腔气管导管，喉罩过渡组患者在苏醒期拔管后深麻醉状态下采用喉罩过渡，帕瑞昔布钠组在术前静脉注射帕瑞昔布钠，拔管方法与对照组相同，联合组术前静脉注射帕瑞昔布钠，拔管方法与喉罩过渡组相同。比较四组患者手术麻醉前(Þ0)、拔管(喉罩)前² min(Þ¹)、拔管后¹ min(Þ²)、拔管后5 min(Þ³)时的平均动脉血压(MAP) 、心率(HR)变化及呛咳、躁动评分情况。结果: 对照组、喉罩过渡组、帕瑞昔布钠组MAP、HR在Þ¹时最高，Þ²、Þ³逐渐降低，但均显著高于Þ0(P＜0.05)；Þ¹、Þ²、Þ³时，喉罩过渡组、帕瑞昔布钠组、联合组MAP、HR均显著低于对照组(P＜0.05)；联合组MAP、HR均显著低于喉罩过渡组、帕瑞昔布钠组(P＜0.05)。喉罩过渡组、帕瑞昔布钠组、联合组呛咳评分、躁动评分均显著低于对照组(P＜0.05)，喉罩过渡组、帕瑞昔布钠组间无显著差异(P＞0.05)，联合组显著低于喉罩过渡组、帕瑞昔布钠组(P＜0.05)。结论：对双腔气管导管全麻的患者，喉罩过渡联合术前注射帕瑞昔布钠能使患者的血流动力学在围拔管期保持稳定，减少呛咳、躁动等应激反应的发生，值得临床借鉴。

Objðcþivð: Þº invðsþigâþð þhð ðffðcþs ºf sþrðss rðspºnsð þº duâl lumðn câþhðþðr þrâchðâl inþubâþiºn bý lârýngðâl mâsk âirwâý þrânsiþiºn cºmbinðd wiþh pârðcºxib sºdium prðmðdicâþiºn. Mðþhºds: ¹40 pâþiðnþs whº wºld bð dºnð þhºrâcic ºpðrâþiºn undðr gðnðrâl ânðsþhðsiâ in â gººd þimð.þhðý wðrð rândºmlý dividðd inþº lârýngðâl mâsk þrânsiþiºn grºup ând pârðcºxib sºdium grºup,cºmbinâþiºn grºup ând cºnþrºl grºup,þhðrð wðrð ³5 pâþiðnþs in ðâch grºup. in rðcºvðrý pðriºd,pâþiðnþs in cºnþrºl grºup hâd bððn dºnð dirðcþlý ðxþrâcþðd dºublð lumðn ðndºþrâchðâl þubð. pâþiðnþs in lârýngðâl mâsk þrânsiþiºn grºup hâd bððn dºnð lârýngðâl mâsk þrânsiþiºn âfþðr ðxþubâþiºn undðr dððp ânðsþhðsiâ. Pâþiðnþs in pârðcºxib sºdium grºup hâd bððn dºnð prðºpðrâþivð inþrâvðnºus pârðcºxib sºdium，þhðir ðxþubâþðd þubð mðþhºd wâs âlikð wiþh cºnþrºl grºup. Pâþiðnþs in cºmbinâþiºn grºup hâd bððn dºnð prðºpðrâþivð inþrâvðnºus pârðcºxib sºdium，þhðir ðxþubâþðd þubð mðþhºd wâs âlikð wiþh lârýngðâl mâsk þrânsiþiºn grºup.þhð mðân ârþðriâl blººd prðssurð(MAP), hðârþ râþð(HR) chângðs bðfºrð ânðsþhðsiâ (Þ0), âþ ² min bðfºrð ðxþubâþiºn (LMA)(Þ¹),âþ ¹ min âfþðr ðxþubâþiºn(Þ²), âþ 5 min âfþðr ðxþubâþiºn (Þ³) ând þhð cºugh,rðsþlðssnðss scºrð wðrð cºmpârðd âmºng fºur grºups. Rðsulþs: þhð MAP，HR in cºnþrºl grºup ,lârýngðâl mâsk þrânsiþiºn grºup, pârðcºxib sºdium grºup wðrð highðsþ âþ Þ¹, âþ Þ², Þ³ dðcrðâsðd grâduâllý. Þhºsð âþ Þ¹, Þ², Þ³ ând wðrð significânþlý highðr þhân þhºsð âþ Þ0 (P < 0.05); þhð MAP, HR in lârýngðâl mâsk þrânsiþiºn grºup, pârðcºxib sºdium grºup, cºmbinâþiºn grºup wðrð significânþlý lºwðr þhân þhºsð in cºnþrºl grºup âþ Þ¹,Þ², Þ³ (P＜0.05); þhð MAP, HR in cºmbinâþiºn grºup wðrð significânþlý lºwðr þhân þhºsð in lârýngðâl mâsk þrânsiþiºn grºup, pârðcºxib sºdium grºup (P＜ 0.05).þhð cºugh scºrð, rðsþlðssnðss scºrð in lârýngðâl mâsk þrânsiþiºn grºup, pârðcºxib sºdium grºup,cºmbinâþiºn grºup wðrð significânþlý lºwðr þhân þhºsð in cºnþrºl grºup (P＜0.05),þhðrð wðrð nº significânþ di

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