成人行心脏手术病人导尿时机的选择和探讨

The Effects of Optimal Time Chosen for Urethral Catheterization in Adult Cardiac Surgery

目的观察优化导尿时机在成人心脏手术中对血流动力学的影响。方法选择23例成人择期心脏手术病人，随机分为2组。采用相同麻醉方式，A组（常规导尿组）：麻醉诱导气管插管后行常规导尿。B组（选择时机导尿组）：在麻醉诱导后病人意识丧失、睫毛反射消失，而此时尚不具备气管插管条件时导尿。监测心率、心律、桡动脉压（ASP）、中心静脉压（CVP），并连续记录诱导前（1时点）、意识丧失（2时点）、意识丧失后1min（3时点；此时为B组导尿时刻）、气管插管即刻（4时点）、气管插管后1min（5时点；此时为A组导尿时刻）5个时点血流动力学指标。结果所有病人无导尿相关不良反应。两组麻醉诱导后血压、心率下降，与A组相比，B组在3时点血压、心率恢复，在5时点无血压、心率过高。结论优化导尿时机选择麻醉诱导用药使病人意识丧失、睫毛反射消失时进行导尿，病人血流动力学更平稳，手术更安全。

Objective To observe the hemodynamics effects of optimal time chosen for urethral catheterization in adult cardiac surgery. Methods 23 patients under cardiac surgery were randomly divided into two groups. All patients were performed same anesthesia induction. The urethral catheterization was completed after intubations in group A. The urethral catheterization was completed right after patients lost consciousness when the intubation was impossible. The hemodynamics data was recorded. Results There had no catheterization related side effect in both groups. The more stable hemodynamics were acquired in group B which was marked by less low blood pressure and heart rate, and less elevated blood pressure and heart rate. Conclusion The urethral catheterization completed right after patients lost consciousness was a good chose in adult cardiac surgery.