15°头高斜坡侧卧位气管拔管对肥胖患者全麻恢复期呼吸功能的影响

Effect of tracheal extubation in the lateral position of 15° head high slope on respiratory function in obese patients during general anesthesia recovery

目的评价15°头高斜坡侧卧位气管拔管对肥胖患者全麻恢复期呼吸功能的影响。方法选择全麻手术患者120例,男62例,女58例,年龄18~65岁,BMI≥28 kg/m2,ASAⅠ或Ⅱ级,采用随机数字表法分为四组,每组30例:平卧位组(C组)、15°头高斜坡仰卧位组(S组)、15°头高斜坡左侧卧位组(L组)和15°头高斜坡右侧卧位(R组)。所有患者均在全麻下完成手术。术毕C组采用平卧位,S组采用15°头高斜坡仰卧位,L组采用15°头高斜坡左侧卧位,R组采用15°头高斜坡右侧卧位。记录入室时(T0)、拔管后1 min(T1)、5 min(T2)、30 min(T3)、2 h(T4)的SpO2、PaO2、MAP和HR;记录拔管时间和出室时间;记录咳嗽、咽痛、喉痉挛和舌后坠等不良反应的发生情况。结果与T0时比较,T1—T4时四组SpO2明显降低(P<0.05),T1—T2时四组MAP明显升高,HR明显增快(P<0.05)。与C组比较,T1—T4时S组、L组、R组SpO2、PaO2明显升高(P<0.05),T1—T2时四组MAP明显降低,HR明显减慢(P<0.05),拔管时间和出室时间明显缩短(P<0.05),L组、R组咳嗽、舌后坠发生率明显降低(P<0.05)。与S组比较,T1—T4时L组、R组SpO2、PaO2明显升高(P<0.05),拔管时间和出室时间明显缩短(P<0.05),咳嗽、舌后坠发生率明显降低(P<0.05)。四组咽痛发生率差异无统计学意义。结论15°头高斜坡侧卧位气管拔管可改善肥胖患者全麻恢复期的氧储备,促进呼吸功能的恢复。

Objective To evaluate the effect of tracheal extubation in the lateral position of 15° head high slope on the respiratory function of obese patients during general anesthesia recovery. Methods A total of 120 patients underwent general anesthesia surgery, 62 males and 58 females, aged 18-65 years, with a BMI ≥28 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were divided into 4 groups using random number table method(n = 30): supine position group(group C), 15° head high slope supine position group(group S),15° head high slope left lateral position group(group L) and 15° head high slope right side(group R). All patients underwent surgery under general anesthesia. SpO2, PaO2, MAP, and HR at the time of entry(T0), 1 min(T1), 5 min(T2), 30 min(T3), and 2 h(T4) after extubation were recorded. The time required from PACU to tracheal tube removal and the time required from PACU to ward return were recorded. Adverse reactions such as cough, sore throat, laryngeal spasm, and tongue drop were recorded. Results Compared with T0, SpO2 was significantly decreased in four groups at T1-T4 (P < 0.05), MAP and HR were significantly increased at T1-T2(P < 0.05). Compared with group C, SpO2, PaO2 in group S, group R, and group L at T1-T4 were significantly increased(P < 0.05), MAP and HR at T1-T2 were significantly decreased(P < 0.05), the time required from PACU to tracheal tube removal and the time required from PACU to ward were significantly shortened(P < 0.05). The incidence of tongue drop and cough in group R and group L were significantly reduced(P < 0.05). Compared with group S, SpO2 and PaO2 in group R and group L were significantly increased(P < 0.05), the time required from PACU to tracheal tube removal and the time required from PACU to ward were significantly shortened(P < 0.05), the incidence of tongue drop and cough was significantly lower(P < 0.05). There was no statistically significant difference in the incidence of pharyngeal pain and laryngospasm in four groups. ConclusionThe tracheal extubation in the lateral position of the 15° head high slope can improve the oxygen reserve during the recovery period of obese patients and promote the recovery of respiratory function.