鼻咽通气道在急重症脑动脉瘤栓塞术患者恢复期的应用

Application of nasopharyngeal airway in cerebral aneurysms embolization during anesthesia recovery in acute severe patients

目的观察恢复期早期拔除气管导管并置入鼻咽通气道对预防急重症脑动脉瘤栓塞术患者拔管期不良反应的效果。方法60例急诊行脑动脉瘤栓塞术的患者，GCS评分8—10分，ASAⅢ-Ⅳ级，随机分为鼻咽通气道组（A组）、口咽通气道组（B组）和手托下颌组（C组），每组20例。记录三组患者拔除气管导管前（T0）、置入鼻／口咽通气道（C组手托下颌）后1min（T1）、5min（T2）、10min（T3）和20min（T4）的SpO2、HR、SBP、DBP、PaCO2、血浆肾上腺素（E）及去甲肾上腺素（NE）浓度（桡动脉血），并观察拔管后20min内的不良反应包括呛咳、躁动、恶心呕吐及喉痉挛等。结果T1时B组HR、SBP、DBP、PaCO2、血浆E及NE浓度高于A组和C组（P〈0．05），A组HR、SBP、DBP、PaCO2、血浆E及NE浓度略高于c组，但差异无统计学意义（P〉0．05）；T2、T3、T4时B组和c组HR、SBP、DBP、PaCO2、血浆E及NE浓度高于A组（P〈0．05）。A组不良反应发生率明显低于B组和C组（P〈0．05）。结论鼻咽通气道应用有利于急重症脑动脉瘤栓塞术患者全麻苏醒期，可有效地保持患者呼吸道通畅并减轻患者拔管期的不良反应。

Objective To observe the adverse reactions in acute severe patients with cerebral aneurysm embolization of early extubation and inserting anasopharyngeal airway during the anesthesia recovery. Methods Sixty patients undergoing emergency cerebral aneurysm embolization, GCS score 8 -10, ASAⅢorⅣ, were randomly divided into three groups： nasopharyngeal airway （group A, n = 20）, oropharyngeal airway （group B, n = 20） and submaxillary -lifting group （group C, n = 20）. SpO2, HR, SBP, DBP, PaCO2, plasma epinephrine （E） and norepinephrine（NE） ： before extubation, 1, 5, 10 and 20 minute after extubation were investigated. The adverse reactions were also recorded in 20 minutes after extubation. Results HR, SBP, DBP, PaCO2, E and NE in group B were higher at T1 than group A and C （P 〈 0. 05）. HR, SBP, DBP, PaCO2, E and NE in group B and C were higher at T2, T3, T4 than group A （P 〈 0.05）. The ratio of adverse reactions in group A was lower than group B and C. Conclusion Nasopharyngeal airway can effectively keep respiratory tract unobstructed and relieve adverse reactions in acute severe patients with cerebral aneurysm embolization during the anesthesia recovery.