氨茶碱用于腹腔镜全麻快速催醒临床观察.DOCVIP

临床医学论文-氨茶碱用于腹腔镜全麻快速催醒临床观察 ? 【摘要】目的：总结氨茶碱用于全麻下行腹腔镜胆囊摘除术２４ ８５６例，术毕气管导管拔除前发生支管痉挛１２８例，氨茶碱治疗效果满意。方法：临床资料，男性５１例，女性７７例，２３~８６岁，体重４８~１０８kg，一旦确诊为支气管痉挛，即刻停止对气道的直接刺激，保持患者安静同时静注ＡＭＬ（总量３０~４０mg/kg）和地塞米松５~１０mg,纯氧通气提高吸入氧气浓度，清除呼吸道分泌物，痉挛症状缓解，哮鸣音，湿罗音消失。Ｐaw≤２０kPa,SPO２≥９６％，呼吸平稳且心率、血压在正常范围。结果：氨茶碱用于全麻催醒及治疗支气管痉挛效果满意。结论：ＡＭＬ治疗全麻苏醒支气管痉挛有独特的优点，一方面，通过抑制细胞内磷酸二酯酶，使支气管平滑肌舒强，起到平喘作用，另一方面，有较强烈的兴奋呼吸，改善肺通气，拮抗吗啡类二氮卓类药引起的中枢抑制等作用，能显著改善和增强骨骼肌张力。 ??? 【关键词】麻醉；氨茶碱；支气管痉挛【Abstract】Ｏbjective:To summarize anLinophylline appling for 128bronchial spasm cases during anaesthesia recovery in 24856 cases imdergpomg gemera;amaestjesoa of laparoscopic cholecystetomy.Methods: The electire laparoscopic cholecgstetomy,men 51 cases,women 77 cases,２３８６ years old,weight ４８１０８kg.when the cases were diagnosised bronchial spasm,we mmediately stopped to stimulate their airway.intravenously injected minophylline(dose３０４０mg/kg）.dexamethasonoe５１０mg and promoted oxygen oncentration.For a moment the symptom of bronchial spasm was remittenced,the asthma whistle and humid rale were disappeared,Ｐaw≤２０kPa,SPO２≥９６％ respiration kept in stable and heard rate.blood pressure kept in normal range.Results: Aminophylline applied for general anaesthesia recovery and treated the bronchial spasm,its effection was satisfied.Conclusions: Aminophylline could restrain phosphodiestetrase to diastolic bronchial smooth muscle and calmed down asthma.In other hand,it also intentively could be exited respirtion,improved pulmonary ventilation,antagoned the central restrain of merphine and benzodiazepines,could obviously improved and enhanced the muscle tension. ??? 【Key words】anaesthesia,aminopylline,bronchial spasm ??? 自Stitr首次报道氨茶碱具有拮抗安全，吗啡作用以来，临床及实验研究证明氨茶碱可用为一种可选用的全麻催醒药，已在国内临床麻醉工作中逐渐推广，我院从９２年开展腹腔镜手术以来，全麻术后催醒全都使用氨茶碱，在１０年麻醉临床中发现，腹腔镜手术全麻患者术毕麻醉苏醒时，出现支气管痉挛用氨茶碱治疗，即可迅速缓解支气管痉挛，又可使患者尽快从麻醉状态中苏醒，起到治疗和催醒双重作用。我院１９９２年至２００２年１２月在全麻下行腹腔镜手术２4 856例。术毕气管导管拔除前发生支气管痉挛１２８例，氨茶碱治疗，效果满意，现报道如下。 ??? 1资料与方法 ??? 11临床资料１２８例中，男５１例,女７７例，２３～８６岁，体重４８～１０８kg，腹腔镜胆囊摘除术１２４例，腹腔镜肝包虫内囊摘除术４例，手术时间１５～４５