支气管哮喘病人全身麻醉51例报告

Analysis on general anesthesia of 51 cases with severe asthma

目的:探讨和观察支气管哮喘患者全身麻醉前预防性用药在围麻醉期的安全性、可行性和有效性。方法:对51例支气管哮喘患者行全身麻醉,分为两组,Ⅰ组27例,术前用沙丁胺醇或氨茶碱,Ⅱ组24例,术前无预防性用药。观察两组麻醉前(T_0)、支气管插管即刻(T_1)、麻醉后30 min(T_2),60 min(T_3)、清醒拔管前(T_4)等各时点的平均动脉压(MAP)、心率(HR)、气道压(Pawp)、呼气末二氧化碳分压(PETCO_2),SpO_2,动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)等数据的变化。结果:Ⅰ组患者均无支气管哮喘发作,Ⅱ组患者有18例支气管发作,两组麻醉前后各时点Pawp、PaO_2、PaCO_2、SpO_2、PETCO_2组内、组间比较差异有统计学意义(P<0.05)。术中哮喘发作时用氯胺酮、地塞米松、麻黄碱等可有效缓解支气管痉挛。结论:术前用硫酸沙丁胺醇和氨茶碱可有效预防哮喘患者麻醉中哮喘发作。氯胺酮治疗急性哮喘发作时为一种有效的治疗方法。

Objective. To investigate and observe the clinical effects and sefety of perianesthetic dose in dealing with severe asthma. Methods.. Fifty one cases with severe asthma underwent surgery with general anesthesia were divided into 2 groups, monitoring before anesthesia （T0）, immediately endobronchial intubation （T1）, after anesthesia 30 min （T2）, 60 min （T3）, resuscitation before extubation （T4） and other points of the mean arterial pressure （MAP）, heart rate （HR）, airway pressure （Pawp）, end-tidal carbon dioxide partial pressure （PETCO2）, SpO2, arterial oxygen pressure （PaO2）, arterial carbon dioxide tension （PaCO2） and other data. Results： Group Ⅰ had not happen severe bronchial spasm intraoperation and 18 cases happened bronchial spasm intraoperation in group Ⅱ and before and after anesthesia comparing with Pawp, PaO2, PaCO2, SpO2, PETCO2 there were significant differences （P〈0.05） in 2 groups. Conclusion： The usage of sulbutamol and aminophylline to prevent perianesthetie asthma is useful.