双腔支气管导管不同拔管方式对患者血流动力学的影响

The effects of different ways of extubation on hemodynamics in patients with double lumen endobroncheal tube

目的:探讨不同拔管方式对插双腔支气管导管的患者拔管时的血流动力学的影响。方法:将30例行双腔支气管插管全麻的胸外科手术的病人随机分为两组,A组为更换单腔气管导管组,B组为瑞芬太尼组,A组患者术毕时将双腔支气管导管更换为单腔气管导管,B组患者手术结束时将双腔支气管导管退至总气管,同时静脉给予瑞芬太尼0.05μg/(kg.min),记录两组患者拔管时间,改良OAA/S评分,拔管时的心率,平均动脉压。结果:两组患者拔管时间,改良OAA/S评分大于等于3分的病人数无显著性差异,拔管时的心率,平均动脉压B组明显低于A组(P<0.05)。结论:插双腔支气管导管的患者拔管时静脉给予0.05μg/(kg.min)的瑞芬太尼能有效降低患者的心血管反应。

Objective： To compare the effects of different ways of extubation on hemodynamics in patients with double lumen endobroncheal tube, Methods ： Thirty ASAⅠ-Ⅱ patients undergoing thoracic surgery with double lumen endobroncheal tube under general anesthesia were randomly divided into 2 groups with 15 patients in each group： patients of group A were changed the double lumen endobroncheal tube into single lumen endobroncheal tube, in the group B,the double lumen endobroncheal tube were moved to trachea from bronchitis at the end of operation and Remifentanil were injected into the patients with 0.05μg/（kg. min）. To observe the time of tracheal extubation , the modified scoring of OAA/S and the mean arterial pressure, heart rate at time of tracheal extubation. Results： The time of tracheal extubation and the modified scoring of OAA/ S in two groups have no significant difference. Comparing with group A, the mean arterial pressure and the heart rate were significant decrease at extubation in group B. Conclusion： Remifentanil intravenous injection before extubation can attenuate the responses to tracheal extubation and the dose of 0. 05μg/（kg·min） seems to be the perfect one for the patients undergoing thoracic surgery with double lumen endobroncheal tube under general anesthesia.