头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响

Effect of the head elevation and hypsokinesis with the extractionangle of 60 degrees on the stress response in patients

目的观察头抬高后仰位联合60°气管拔管对患者拔管期应激反应的影响。方法选择全麻下行大隐静脉高位结扎手术的患者90例,男33例,女57例,年龄18~40岁,体重45~75kg,ASAⅠ或Ⅱ级。按照随机数字表法均分为三组,每组30例。A组患者平卧位,气管导管拔管角度为90°（拔管方向与地面夹角呈90°）,B组患者平卧位,拔管角度为60°（拔管方向与地面夹角呈60°）,C组患者头抬高后仰位,拔管角度为60°。记录手术结束时（T_0）、拔管前1 min（T_1）、拔管后1 min（T_2）、5min（T_3）的SBP、DBP及HR,记录拔管的力度,观察呛咳、咽痛、声音嘶哑发生情况。结果与T_0时比较,T_2时三组SBP、DBP明显升高,HR明显增快（P〈0.05）,T_3时A、B组SBP、DBP明显升高,HR明显增快（P〈0.05）;T_2、T_3时B、C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于A组（P〈0.05）;T_2、T_3时C组SBP、DBP明显低于,HR明显慢于,拔管力度明显小于B组（P〈0.05）。B、C组呛咳发生率[3例（10.0%）,2例（6.6%）]明显低于A组的[12例（40.0%）]（P〈0.05）。结论头抬高后仰位联合60°拔除气管导管能明显减轻患者拔管期应激反应。

Objective To observe the effect of the head elevation and hypsokinesis with the extraction angle of 60°on the stress response in patients.Methods Ninety patients who were treated with the great saphenous vein high ligation surgery were divided into three groups according to the random number table method,with 30 in each group.Patients in group A with supine position,the angle of tracheal extubation was 90°（90°from the angle of the ground）;patients in group B with supine position,the angle was 60°（60°from the angle of the ground）;patients in group C with head selevation and hypsokinesis,the angle was 60°.SBP,DBP,HR and extubation force were recorded at the end of the operation（T_0）,1minute before extubation（T_1）,1 minute after extubation（T_2）,5minutes after extubation（T_3）,and the occurrence of bucking,sore throat,hoarseness were observed.Results The SBP,DBP,HR at T_2 were significantly higher than those at T_0 in all groups（P〈0.05）,while the SBP,DBP,HR at T_3 were significantly higher than those at T_0 in only groups A and B（P〈0.05）.The differences of those indicators between T_3 and T_0 had no statistical significance in group C.The SBP,DBP,HR at T_2,T_3 and the extubation force were significantly decreased in group B and group C compared with group A（P〈0.05）.Compared with group B,the SBP,DBP,HR at T-2,T_3 and the extubation force were significantly decreased in group C（P〈0.05）.The incidence of choking in group B [3（10.0%）]and group C [2（6.6%）]was significantly decreased than that in group A [12cases（40.0%）]（P〈0.05）.Conclusion The head elevation and hypsokinesis with the extraction angle of 60°can significantly reduce stress reaction in patients during the extubation.