不同留置尿管时机全麻患者麻醉复苏期的反应比较

Optimal timing of indwelling catheterization in general anesthesia patient and patient's response to anesthesia during resuscitation

目的比较不同留置尿管时机全麻患者的麻醉复苏期反应。方法将2014年4月至2016年5月在我院行全身麻醉手术并术前需导尿患者180例按随机数字表法分为A、B、C三组,每组60例。A组患者术前在病房导尿并留置尿管,B组患者在全身麻醉插管后导尿并留置尿管,C组患者在麻醉诱导期进行导尿并留置尿管。比较三组患者导尿前及导尿时的收缩压(SBP)和舒张压(DBP)、患者复苏期的躁动情况,术后观察了解患者对尿管的耐受情况和对舒适度的评定。结果 A组患者导尿时血压[SBP=(127.88±14.55)mmHg,DBP=(76.08±9.63)mmHg,1 mmHg=0.133 kPa]与导尿前[SBP=(118.20±14.25)mmHg,DBP=(69.65±7.82)mmHg]比较明显升高,C组患者导尿时血压[SBP=(124.95±12.92)mmHg,DBP=(76.76±10.28)mmHg]与导尿前[SBP=(117.83±14.96)mmHg,DBP=(68.96±11.11)mmHg]比较也有所上升,差异均具有统计学意义(P<0.05),而B组患者血压导尿前和导尿时比较差异均无统计学意义[导尿前SBP=(121.05±18.10)mmHg,DBP=(71.45±10.91)mmHg;导尿时SBP=(122.93±18.21)mmHg,DBP=(72.30±11.72)mmHg]。C组患者在麻醉复苏期发生躁动12例(20.00%),明显低于A组的29例(48.33%)和B组的36例(60.00%),差异均具有统计学意义(P<0.05);C组患者中舒适0级者49例(81.66%),明显高于A组的34例(56.67%)和B组的23例(38.33%),差异均具有统计学意义(P<0.05)。结论全身麻醉诱导期留置尿管既可减少患者复苏期躁动的发生,又可提高患者的舒适度,推荐为全麻患者留置尿管的最佳时机。

Objective To explore the optimal timing of indwelling catheterization in general anesthesia patient and patient＇s response to anesthesia during resuscitation. Methods A total of 180 general anesthesia patients, who ad-mitted to our hospital and underwent preoperative catheterization, were selected and divided into A group, B group and C group according to the random number table method, with 60 cases in each group. The patients in A group were treat-ed with catheterization and indwelling catheter before surgery in the ward; the patients in B group were treated with catheterization and indwelling catheter after general anesthesia with tracheal intubation; the patients in C group were treated with catheterization and indwelling catheter during anesthesia induction. The systolic blood pressure （SBP） and diastolic blood pressure （DBP） before and after catheterization and the restlessness of the patients during general anes-thesia in the three groups were compared. The patient＇s tolerance to the catheter and the assessment of comfort after the treatment were observed. Results In A group, the SBP and DBP during the catheterization were respectively （127.88± 14.55） mmHg and （76.08±9.63） mmHg, which were significantly higher than corresponding （118.20±14.25） mmHg and （69.65 ± 7.82） mmHg before the catheterization （P〈0.05）;in C group, the SBP and DBP during the catheterization were respectively （124.95 ± 12.92） mmHg and （76.76 ± 10.28） mmHg, which were also significantly higher than corresponding （117.83±14.96） mmHg and （68.96±11.11） mmHg before the catheterization （P〈0.05）;the SBP and DBP during and after the catheterization in B group were respectively （121.05 ± 18.10） mmHg, （71.45 ± 10.91） mmHg and （122.93 ± 18.21） mmHg, （72.30 ± 11.72） mmHg, and there was no significant difference. The incidence cases of restlessness in C group was 12 cases （20.00%）, which was significantly lower than 29 cases （48.33%） in A group and 36 cases （60.00%） in B group （P〈0.05）. The rate of comfort for 0 grade in C group was 49 cases （81.66%）, which was significantly higher than 34 cases （56.67%） in A group and 23 cases （38.33%） in B group （P〈0.05）. Conclusion Indwelling catheter during induction of general anesthesia can not only reduce the restlessness of during the patient＇s recovery period, but also improve patient comfort, therefore, which can be recommended as the best time of indwelling catheter for general anesthesia patient.