摘要
目的 探讨全身麻醉手术患者达到气管拔管指征时右侧膈肌厚度变化率的超声评价。方法 选择择期行非胸腹部全身麻醉手术患者 89 例,随机分为男性组(46 例)和女性组(43 例),术中根据生命体征变化调整麻醉用药,维持足够的麻醉深度,术毕前 30 min 停用肌松药并给予 0.8 μg/kg 右美托咪定。术毕患者进入麻醉恢复室,采用 5 ~ 10 MHz 超声探头在腋前线和腋中线之间,通过第 8 ~ 10 肋间,使用 M 型超声记录拔管时、拔管后 30 min 膈肌厚度变化指标,包括吸气末膈肌厚度 DTei (diaphragmatic thickness at the end of inspiration) 和呼气末膈肌厚度 DTee (diaphragmatic thickness at the end of expiration) ,并计算膈肌厚度变化率 DTF (diaphragmatic thickness fraction)。同时记录拔管时间和拔管时 Ramsay 镇静评分。结果 与术前 [ 男(59.63±10.38)%,女(57.72±9.59)%] 比较,两组拔管时 DTF[ 男(38.28±6.37)%,女(40.51±7.81)%] 差 异 均 有 统 计 学 意 义( 均 P < 0.05), 拔 管 后 30 min[ 男(58.37±9.64)%, 女(56.09±8.73)%] 两组 DTF 差异均无统计学意义(均P > 0.05);与拔管时比较,拔管后 30 min 两组DTF 差异均有统计学意义(均P < 0.05)。两组拔管时间和 Ramsay 镇静评分比较,差异无统计学意义(均P > 0.05)。结论 在全身麻醉恢复期应用超声评估右侧膈肌厚度变化率具有可行性,对于判断气管拔管时机有一定的临床应用价值。
Objective To evaluate the ultrasonographic value of right diaphragm thickness in patients taking general anesthesia and having signs for tracheal extubation. Methods Eighty-nine patients undergoing non-thoracic and abdominal surgery under general anesthesia were randomly assigned into a male group (46 cases) and a female group (43 cases). The anesthetic was adjusted according to the vital signs during operation. The muscle relaxants was stopped and 0.8 μg/kg dexmedetomidine was administrated 30 min before the end of the surgery. 5-10 MHz ultrasound probe was used to placeover 8-10 intercostal space between the anterior axillary line and the axillary line. The right diaphragmatic thickness at the end of inspiration and expiration through M-type mode during extubation and 30 min after extubation were measured, then the diaphragmatic thickness fraction(DTF) was calculated. The time from stopping muscle relaxants to extubation and Ramsay sedation score when extubation were also recorded. Results Compared with those before operation [male (59.63±10.38)%, female (57.72±9.59)%], there were statistical differences in the DTF when extuation [male (38.28±6.37)%, female (40.51±7.81)%] (P 〈 0.05) but no in the DTF 30 min after extubation [male (58.37±9.64)%, female (56.09±8.73)%] (P 〉 0.05) in the two groups. Compared with those when extubation, there were statistical differences in the DTF 30 min after extubation in both groups (P 〈 0.05). There were no statistical differences in the extubation time and Ramsay sedation score between the two groups (P 〉 0.05). Conclusions It is feasible to evaluate the change of right diaphragm thickness by ultrasound in the recovery period of general anesthesia, which may be of clinical significance in judging tracheal extubation.
出处
《国际医药卫生导报》
2017年第23期3657-3660,共4页
International Medicine and Health Guidance News
基金
福建省自然科学基金计划项目(2017J01246)
关键词
超声
膈肌
厚度
拔管
全身麻醉
Ultrasound
Diaphragm
Thickness
Extubation
General anesthesia