全麻恢复病人气管拔管时机的临床探讨

CLINICAL STUDY OF GENERAL ANESTHESIA AND TRACHEAL ESTUBATION IN PATIENTS WITH TIME

目的：探讨妇产科全麻恢复病人气管拔管时机，并就拔管前后相关并发症进行观察。方法：妇产科手术择期全麻恢复病人100例手术后随机分组对照观察。拔管前后用Rammasy改良评分判断病人的意识状况。根据Ramsay评分将病人分组进行观察，A组Ramsay评分在3～4分时，当病人自主呼吸恢复，意识未完全恢复，脱机观察2min无缺氧表现后拔除气管导管。B组病人当Rammasy评分在1～2分时拔除气管导管。记录气管拔管前后血压、心率、呼吸、呛咳、躁动等情况及病人对气管插管的感受。结果：吸痰时和拔管前血压、心率、呼吸改变B组较A组明显（P〈0．05，P〈0．01），明显呛咳、躁动和其他并发症的发生率A组较低，两组差异性显著（P〈0．01）。拔管后明显舌根后坠A组占20％，两组差异性显著（P〈0．01）。拔管前对气管插管的感受，B组有48％自述难以忍受，A组仅6％感觉难受，两组差异性显著（P〈0．01）。结论：Ramsay评分在3—4分时气管拔管，病人舒适度明显提高，并可预防全麻恢复期气管拔管并发症。

Objective： To investigate the obstetric anesthesia recovery of patients with tracheal extubation, and related complications were observed before and after extubatioa. Methods：Obstetrics and gynecology operation undergoing restoration in 100 patients after operation were randomly grouping and controlled observation. With the modified Rammasy score before and after extubation in judging the patient＇s state of consciousness. According to Ramsay score , patient were observed in A group, Ramsay score in three or four points, when the recovery of patients with spontaneous breathing, consciousness is not fully restored, off- line observation of 2min no hypoxia after tracheal extubation. The patients in group B when the Rammasy score in 1 - 2 minutes of tracheal extubation, the blood pressure before and after tracheal extubation, heart rate, respiration, choking cough, agitation and situation of patients to tracheal intubation feelings were recorded. Results：The sputum and blood pressure, heart rate before extubation, respiratory changes in B group than in A group （ P＆lt; 0.05, P＆h; 0.01 ）, choking, agitation and other complication rates were lower in the A group, the differences between the two groups was significant （P＆lt; 0.01 ）. After extubation obviously tongue retropulsion group A 20%, two groups have significant difference （ P＆lt ; 0.01 ）. Before extubation of tracheal intubation, group B 48% readme unbearable, group A only 6% feel uncomfortable, the differences between the two groups was significant （P＆lt; O. 01 ）. Conclusion：Ramsay score at 3 to 4 tracheal tube, the comfort degree of patients improved obviously, which can prevent the recovery period of general anesthesia tracheal tube complications.