PACU患者深麻醉状态下拔管的效果观察

Effect of extubation with PACU patients under deep anesthesia

1目的探讨麻醉恢复室(post-anesthesia care unit,PACU)患者深麻醉状态下拔管的效果。2方法选择气管插管全麻术后带管送入PACU患者72例,采用随机数字表法分为观察组和对照组,各36例。观察组手术结束不停用丙泊酚,待自主呼吸恢复、潮气量、每分钟通气量在正常范围,脱氧呼吸5分钟、脉搏血氧饱和度(SPO_2)>95%、有吞咽动作,拔管后再停药;对照组则完全停用丙泊酚,自主呼吸恢复、潮气量、每分钟通气量在正常范围、脱氧呼吸5分钟、SPO_2>95%、有吞咽动作、意识清醒后再拔除气管导管。比较两组患者拔除气管插管前后5分钟的呼吸频率、心率、平均动脉压,评估患者镇静评分(Ramsay sedation scale RSS)和拔管后相关并发症的发生率。3结果观察组拔除气管导管前后5分钟的呼吸频率、心率、平均动脉压较对照组低,镇静评分均较对照组高;观察组患者拔管后相关并发症的发生率较对照组低,差异均有统计学意义(P<0.05)。4结论 PACU患者深麻醉状态下拔管,血流动力学稳定,拔管后相关并发症的发生率明显降低,保证了患者顺利渡过麻醉苏醒期。

Objective To explore the effects of extubation with post-anesthesia care unit（PACU）patients under deep anesthesia.Methods A total of 72 PACU patients were selected,all of whom were with tubes after general anesthesia surgery with endotracheal intubation.The patients were randomly divided into the observation group（n=36）and the control group（n =36）.For the observation group,propofol was continued to be used after surgery,spontaneous respiration was recovered.Tidal volume and minute volume were among the normal range,deoxidization breathing was 5minitus,SPO_295%.The patients had swallowing act.After extubation,the patients stopped medication.The control group stopped using propofol completely.Spontaneous respiration was recovered.Tidal volume and minute volume were among the normal range,deoxidization breathing was 5minitus,SPO_295%.The patients had swallowing act.After awareness of the patients,the tubes were withdrawn.The two groups of patients were compared for breathing rate,heart rate and mean arterial pressure at 5minitus before extubation and 5minitus after extubation.The patients were evaluated on Ramsay sedation scale（RSS）sedation scores and incidence of related complications after extubation.Results Breathing rate,heart rate and mean arterial pressure at 5minitus before and after extubation in observation group were lower than those of the control group;Ramsay sedation scores at 5minitus before and after extubation were higher than the control group;and incidences of related complications after extubation were lower in the observation group than the control group,and the differences was statistically significance（P〈0.05）.Conclusion Extubation of PACU patients under deep anesthesia has stable hemodynamic.The incidence of complications related to extubation was obviously decreased.And the patients can be ensured to smoothly pass the anesthetic recovery period.