小剂量丙泊酚在全麻拔管期中的应用_临床医学论文.docVIP

小剂量丙泊酚在全麻拔管期中的应用_临床医学论文 小剂量丙泊酚在全麻拔管期中的应用_临床医学论文 【摘要】 　　目的：观察小剂量丙泊酚在全麻拔管期对患者的影响。方法:将40例ASAⅠ～Ⅱ级全麻手术后患者，随机分为两组：丙泊酚组（Ⅰ组）于手术结束达到拔管条件，静脉注射丙泊酚1mg·kg-1， 2min后吸痰拔管；对照组(Ⅱ组) 达到拔管条件，不予镇静，吸痰后拔除气管导管。观察各组拔管前5min、拔管即刻、拔管后5min时的心率（HR）、平均动脉压（MAP）、呛咳反应、拔管后清醒时间、拔管知晓率。结果:Ⅰ 组拔管期MAP、HR值较稳定，与拔管前比较差异无统计学意义（Pgt;0.05）；Ⅱ 组拔管即刻、拔管后5min时MAP、HR较拔管前均明显增加（0.01或0.05）。Ⅰ 组患者术后清醒时间明显长于Ⅱ 组（0.05），Ⅱ 组重度呛咳反应发生率、拔管知晓率较Ⅰ 组明显增高（0.01或0.05）。结论: 小剂量丙泊酚可用于抑制全麻拔管期反应。 【关键词】 气管拔管；丙泊酚；全身麻醉 ［ABSTRACT］ Objective: To investigate the effects of lowtubation period. Methods: Forty general anesthesia cases categorized as ASA ⅠⅡ grade were randomly divided into propofol group (groupⅠ) and control group (groupⅡ). Patients in groupⅠ, were administrated with 1 mg/kg propofol when the operation was over and anesthesia tube was about to be removed in 2 min after sputum suction. While for groupⅡ, anesthesia tube was directly removed after sputum suction. Heart rate, mean arterial blood pressure at three time points including 5 min before and after the extubation, the extubation moment, were recorded and compared. Cough response at extubation, time of consciousness regain after extubation, and rate of extubation awareness were also observed. Results: For group Ⅰ, heart rate, mean arterial blood pressure after extubation were stable compared with that before the extubation, while for group Ⅱ, the same parameters increased significantly after extubation (0.01 or 0.05) . Group Ⅰ showed longer time of consciousness regain(0.05), while lower rate of severe cough response and extubation awareness (0.01 or 0.05). Conclusion: Lowdose propofol is effective on suppressing responses during anesthesia extubation period. ［KEY WORDS］ Extubation; Propofol; General anesthesia 全身麻醉手术结束后，随着麻醉药物的消除，意识的恢复，患者留置导管的反应逐渐增强，尤其是吸痰、拨管的刺激，更易引起明显的呛咳、躁动及剧烈的血流动力学变化［1］，拔管期的知晓亦给患者造成精神创伤。本文主要观察全麻拔管期患者应用丙泊酚后气管拔管对血流动力学，呛咳反应，拔管后清醒时间及拔管知晓等情况的影响，旨在观察小剂量丙泊酚在气管拔管中应用的可行性。 　　1 资料与方法 　　1.1 一般资料 选择ASA I～Ⅱ级全麻手术后患者40例，其中男性21例，女性19例；年龄20～62岁，平均41岁，体重42～68kg。所有患者均无精神及中枢神经系