一种新型俯卧位摆放方法对全身麻醉效果的影响

The effect of a new prone position for general anesthesia

目的：探讨一种新型俯卧位摆放方法对全身麻醉（全麻）效果的影响。方法回顾性研究50例患者资料，均需在全麻俯卧位下手术，在环甲膜穿刺气管内表面麻醉后，采用纤支镜引导清醒气管插管，成功后患者根据自身的舒适度配合医务人员摆放俯卧位，然后行诱导麻醉，开始手术。记录患者进入手术室后不同时间点收缩压（SBP）、舒张压（DBP）、心率（HR）和各时间点 HR 和收缩压的乘积（RPP）。结果33例患者顺利完成整个操作过程，插管过程各项记录指标与基础状态相比差异均无统计学意义（均 P ＞0．05）。17例患者在首次插管出现不适，SBP、DBP、HR 和 RPP 分别为（159．2±25．9）mmHg、（97．2±11．6）mmHg、（98．2±9．0）次／min 和（16028±6725），均高于基础值（t ＝2．698，2．802，5．720，8．905，均 P ＜0．05），应用小剂量镇静药物后顺利完成第二次插管，二次插管插管时 SBP、DBP、HR 和 RPP 分别为（144．0±18．5）mmHg、（83．0±10．5）mmHg、（89．3±10．0）次／min 和（12658±5521），与基础值相比差异均无统计学意义（均 P ＞0.05）。结论全麻下俯卧位手术的患者，在纤支镜引导下清醒气管插管后患者自行摆放俯卧位的方法，技术简单，易于操作，而且可以减轻医务人员工作量，减少并发症，是一种可供选择的方法。

Objective To explore the effect of a new prone position for general anesthesia.Methods 50 patients in the group were made a retrospective study：All the 50 patients needed prone position surgeries under general anesthesia.After awake flexible fiberoptic intubation,with the anesthesia of thyrocricoid puncturing the intra-trachea surface,has been taken,patients lied in the prone position according to their own comfort with the guide of medical staff,which was followed by anesthesia induction and the operation.The SBP,DBP,HR and RPP were recor-ded at different point of time after patients entered the operation room.Results 33 cases of 50 patients completed the whole process successfully and the indexes at the time of the intubation had no significant difference with those at basic state（all P 〉;0.05）.17 operations suffered discomfort.The SBP,DBP,HR and RPP in these patients were （159.2 ±25.9）mmHg,（97.2 ±11.6）mmHg,（98.2 ±9）beats per minute and （16 028 ±6 725）respectively, which were higher than those at basic state（t =2.698,2.802,5.720,8.905,all P 〈0.05）.After applications of small dose sedative,these patients were successfully tracheal intubated.The SBP,DBP,HR and RPP were （144.0 ± 18.5）mmHg,（83.0 ±10.5）mmHg,（89.3 ±10.0）beats per minute and （12 658 ±5 521）respectively at the time of the second intubation,which had no significant difference with those at basic state（all P 〉;0.05）.Conclusion It is technically simple and easy to operate,the way that patients waiting for prone position surgeries lie in the prone position by themselves with awake flexible fiberoptic intubation lightens the workload of medical staff and reduces complications of the intubation,which is optional in clinical situations.