摘要
【目的】探讨全麻术后使用芬太尼对病人气管拔管的影响。【方法】987例气管插管全身麻醉的手术病人随机分为对照组(C组,n=498)和芬太尼组(F组,n=489)。对照组按常规静吸复合全麻,芬太尼组在手术结束前1 h提前关闭吸入全麻药,改用芬太尼维持麻醉。手术停止后,分别记录每组病人的吞咽反射、呼吸通气量恢复时间,清醒时间,拔管时间。同时记录病人有无剧烈呛咳、躁动,拔管后有无出现异常呼吸及拔管时病人的血压、脉搏、呼吸、脉搏氧饱和度。【结果】两组病人一般资料,手术方式差异无显著性。F组病人拔管时躁动、应激反应的发生率、吞咽反射、呼吸通气量恢复正常的时间,清醒的时间均明显低于对照组(P<0.01),同时拔管的时间也早于对照组(P<0.05),而拔管后出现异常呼吸的发生率无显著性(P>0.05)。【结论】气管插管全身麻醉中,于手术结束前提前关闭吸入麻药,改用芬太尼维持麻醉,能明显减少病人躁动、应激反应的发生率,同时能缩短病人吞咽反射、呼吸通气量的恢复时间,加快病人的清醒,缩短拔管时间。
[Objective] To study the security and controllability of tracheal extubation after operation under general anesthesia. [Methods] Nine hundred and eighty seven patients with ASA physical status I～II were randomly divided into two groups： control group（C group, n =498） and fentanyl group（F group, n =489）. Control group were induced by intravenous drugs and maintained by isoflurane and the volatile anesthetic was maintained fight up to the end of the procedure. In fentanyl group, patients were changed fentanyl to maintain anesthesia one hour before the end of operation turning off the vaporizer. After operation, the recovering time of the deglutition reflex and the minute ventilation, the time of awake and tracheal extubation were recorded. The patient＇s severe chocking cough and restlessness were recorded at extubation simultaneously. Abnormal breathing was recorded after extubation. BP （SBP, DBP, MAP）, HR, RR, SpO2 and EtCO2 were recorded immediately before tracheal extubation. [Results] There were no significant differences in sex, age, body weight and operative method between the two groups. The cases of restlessness and stress responses in F group were significantly less than those in C group （ P〈 0.01）. The recovering time of the deglutition reflex, the minute ventilation and the awake time in F group were significantly shorter than those in C group （ P 〈0. 01）. The time to tracheal extubation in F group was shorter than that in C group （ P 〈0.05）. There were no significant differences in abnormal breathing after extubation between the two groups （ P〉0. 05）. [Conclusion] Surgical patients undergoing isoflurane, being changed fentanyl to maintain before the end of operations turning off the vaporizer, can significantly reduce the high incidence of restlessness and stress responses, and shorten the recovering time of the deglutition reflex and the minute ventilation, and quicken awake time and shorten the time to tracheal extubation.
出处
《医学临床研究》
CAS
2008年第2期196-198,共3页
Journal of Clinical Research
