意识水平及气管切开状态对高压氧治疗患者血压及心率的影响

Effects of consciousness level and tracheotomy status on blood pressure and heart rate in patients undergoing hyperbaric oxygen therapy

目的观察不同意识水平及气管切开(以下简称气切)状态对高压氧(HBO)治疗患者血压及心率的影响。方法选取2021至2022年在解放军南部战区总医院高压氧科治疗的72例患者作为研究对象。根据意识水平及气切状态分为4组,意识清楚无气切组(n=11)、意识清楚有气切组(n=14)、意识障碍无气切组(n=10)和意识障碍有气切组(n=37)。监测患者在进舱前、加压阶段(加压后15 min)、稳压1阶段(加压后45 min)、稳压2阶段(加压后65 min)及减压阶段(加压后95 min)5个时间点的血压及心率。结果与加压前相比,意识清楚无气切组患者舱内血压、心率变化不明显(P>0.05),其余3组患者舱内血压升高(P>0.05),但心率变化不明显(P>0.05)。在加压阶段及稳压阶段,意识障碍组患者较意识清楚组心率减慢(P<0.05),无气切组患者较有气切组舱内血压及心率变化不明显(P>0.05),意识障碍无气切组较意识清楚无气切组血压升高、心率加快(P<0.05)。舱内所有阶段意识障碍有气切组患者较意识清楚有气切组心率减慢(P<0.05),意识障碍无气切组患者较意识清楚无气切组血压升高、心率加快(P<0.05)。结论在HBO治疗前后,不同意识水平和气切状态患者的心率变化不明显,但会升高血压;在治疗过程中,意识障碍可致血压升高,心率下降;气切状态对治疗过程中的心率和血压影响不明显。

Objective To observe the effects of different levels of consciousness and tracheotomy statuses on blood pressure and heart rate in patients undergoing hyperbaric oxygen(HBO)treatment.Methods A total of 72 patients receiving HBO treatment admitted to the Department of Hyperbaric Oxygen of General Hospital of PLA Southern Theater Command from 2021 to 2022 were selected as the research subjects.According to the level of consciousness and the status of tracheotomy,the patients were divided into four groups:clear consciousness without tracheotomy(n=11),clear consciousness with tracheotomy(n=14),consciousness disorder without tracheotomy(n=10),and consciousness disorder with tracheotomy(n=37).The blood pressure and heart rate of the patients were monitored at five time points:before entering the cabin,pressurization stage(15 mins after pressurization),pressure stabilization stage one(45 mins after pressurization),pressure stabilization stage two(65 mins after pressurization),and decompression stage(95 mins after pressurization).Results Compared with those before pressurization,there was no significant change in cabin blood pressure and heart rate in the clear consciousness without tracheotomy group(P<0.05).Compared with those before pressurization,in the other three groups,the cabin blood pressure increased(P<0.05),but the heart rate did not change significantly(P>0.05).During the pressurization and pressure stabilization stages,the patients in the consciousness disorder groups had slower heart rate than those in the clear consciousness groups(P<0.05),the patients in groups without tracheotomy had no significant change in blood pressure or heart rate in the cabin compared with those in groups with tracheotomy(P>0.05),and the patients in the consciousness disorder without tracheotomy group had higher blood pressure and faster heart rate than those in the clear consciousness without tracheotomy group(P<0.05).At all stages in the cabin,the heart rate of patients in consciousness disorder with tracheotomy group was slower than that in clear consciousness with tracheotomy group(P<0.05),while the patients in consciousness disorder without tracheotomy group had higher blood pressure and faster heart rate than those in the clear consciousness without tracheotomy group(P<0.05).Conclusion Before and after HBO treatement,the different consciouness level and status of trache-otomy had no significant effect on the heart rat,but it would increase blood pressure,during treatment,disorder of consciousness can increased blood pressure and decreased heart rat,tracheotomy status had no significant effect on heart rat and blood pressure during treatment.