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保留自主呼吸喉罩全麻对行胸廓内固定装置取出术患者康复效果研究
作者:方宁1 2  刘君1  黄理进2  黄健2  黄汉清2 
单位:1. 广州医科大学 研究生院, 广东 广州 510182;
2. 茂名市人民医院 胸外科, 广东 茂名 525200
关键词:自主呼吸 肋骨骨折 胸廓内固定装置 康复 
分类号:R614.2
出版年·卷·期(页码):2022·50·第一期(80-84)
摘要:

目的:观察保留自主呼吸喉罩全麻对行胸廓内固定装置取出术患者康复效果的影响。方法:选取2019年1月—2020年1月在茂名市人民医院气管插管复合全麻下行胸廓内固定装置取出术患者为对照组(43例),再2020年1月至2021年1月在我院保留自主呼吸喉罩全麻下行胸廓内固定装置取出术患者为试验组(43例),包括行肋骨及胸骨骨折切开复位内固定术和漏斗胸、鸡胸微创矫治术患者。比较两组患者手术一般情况、术后恢复情况、炎症指标等的差异。结果:两组患者麻醉准备时间、手术时间无差别,试验组术中最低血氧饱和度(SpO2)水平稍优于对照组,但差异无统计学意义;试验组术后苏醒时间和术后住院时间较对照组短,术后24 h疼痛视觉模拟评分法(visual analogue scale,VAS)低于对照组,差异有统计学意义(P<0.05);术后白细胞计数、C反应蛋白、降钙素原和白介素-6水平均低于对照组,差异有统计学意义(P<0.001);患者术后血糖、肿瘤坏死因子-α水平低于对照组(P<0.001);患者躁动、尿潴留、呼吸道分泌物过多、咽喉疼痛发生率低于对照组(Fisher值<0.001)。结论:保留自主呼吸喉罩全麻下行胸廓内固定装置取出术的应用效果较好,可抑制术后炎症反应,降低术后并发症率,促进康复进程,具有临床应用价值。

Objective:To observe the effect of laryngeal mask general anesthesia with autonomous breathing on the rehabilitation of patients undergoing removal of thoracic internal fixation device. Methods: The patients who underwent thoracic internal fixation under endotracheal intubation combined with general anesthesia in Maoming people's Hospital from January 2019 to January 2020 were selected as the control group(43 cases), and the patients who retained spontaneous breathing laryngeal mask general anesthesia in our hospital from January 2020 to January 2021 were selected as the experimental group(43 cases), Including open reduction and internal fixation of rib and sternal fractures and minimally invasive correction of funnel chest and chicken chest. The differences of general operation, postoperative recovery and inflammatory indexes between the two groups were compared. Results: There was no difference in anesthesia preparation time and operation time between the two groups. The lowest intraoperative blood oxygen saturation(SpO2) level in the experimental group was slightly better than that in the control group, but the difference was not statistically significant; The postoperative recovery time and postoperative hospital stay in the experimental group were shorter than those in the control group. The score of visual analogue scale(VAS) of pain 24 hours after operation was lower than that in the control group, the difference was statistically significant(P<0.05); The postoperative leukocyte count, C-reactive protein, procalcitonin and interleukin-6 water were significantly lower than those in the control group(P<0.001); Postoperative blood glucose and tumor necrosis factor- α The level was lower than that in the control group(P<0.001); The incidence of restlessness, urinary retention, respiratory secretion and throat pain were lower than those in the control group(Fisher* <0.001).Conclusion: The application effect of thoracic internal fixation device removal under general anesthesia with autonomous breathing laryngeal mask is good, which can inhibit postoperative inflammatory reaction, reduce postoperative complication rate and promote rehabilitation process. It has clinical application value.

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