不同体位深度镇静下气管拔管的应激反应和安全性比较

Comparison of Stress Response and Safety of Tracheal Extubation Under Different Body Position and Deep Sedation

目的探讨不同体位深度镇静下气管拔管的应激反应和安全性差异,为深度镇静下气管拔管体位选择提供参考。方法将2020年7月-2021年6月气管插管全身麻醉下行择期腹腔镜胆囊切除手术患者120例分为A组(n=60)和B组(n=60)。A组采用侧卧位深度镇静下气管拔管,B组采用仰卧位深度镇静下气管拔管。监测比较两组手术结束时(T_(0))、拔管前1min(T_(1))、拔管后1min(T_(2))、拔管5min(T_(3))的收缩压(SBP)、舒张压(DBP)和心率(HR)等应激反应指标。统计比较两组舌后坠发生率,并统计比较两组麻醉苏醒前哮鸣音、喉痉挛、咳嗽、躁动以及术后咽部不适、咳嗽、肺炎等不良反应发生率以评价安全性。结果与T0比较,两组T_(2)、T_(3)的SBP和DBP均升高而同期HR加快(P<0.05);且A组T_(2)、T_(3)的SBP和DBP均低于B组而HR慢于B组(P<0.05)。A组舌后坠发生率为8.33%(5/60),低于B组的25.00%(15/60)(P<0.05)。两组麻醉苏醒前哮鸣音、喉痉挛、咳嗽、躁动以及术后咽部不适、咳嗽、肺炎等不良反应发生率比较差异无统计学意义(P>0.05)。结论侧卧位深度镇静下气管拔管更有利于减轻应激反应和减少舌后坠的发生,且安全可靠。

Objective To explore the difference of stress response and safety of tracheal extubation under different posture and depth sedation,and to provide reference for the selection of tracheal extubation position under deep sedation.Methods 120 patients with selective laparoscopic cholecystectomy under general anesthesia from July 2020 to June 2021 were divided into group A(n=60)and group B(n=60).The tracheal tube was pulled out under deep sedation condition in the side lying position in group A and that in group B was performed in supine position.The stress response indexes SDP,DBP and HR of the two groups were monitored and compared at the end of operation(T_(0)),1 min before extubation(T_(1)),1 min after extubation(T_(2)),after extubation 5 min(T_(3)).The rate of tongue fall in the two groups was statistically compared,and the rate of before anesthesia recovery asthma,laryngospasm,cough,restlessness,and postoperative pharyngeal discomfort,cough and pneumonia in the two groups were compared to evaluate the safety.Results Compared with those of T0,SBP and DBP of T_(2)and T_(3)in both groups were increased,while HR in the same period in both groups was accelerated(P<0.05).The SBP and DBP of T_(2)and T_(3)of group A were lower than that of group B,while in the same period HR of group A was slower than that of group B(P<0.05).The rate of lingual fall in group A was 8.33%(5/60),which was lower than that of group B 25.00%(15/60)(P<0.05).There was no significant difference in the rate of adverse reactions such as before anesthesia recovery asthma,laryngospasm,cough,restlessness,and postoperative pharyngeal discomfort,cough and pneumonia between the two groups(P>0.05).Conclusion The tracheal extubation under deep sedation in lateral position is more beneficial to reduce stress response and the occurrence of tongue falling,which is safe and reliable.