全麻手术后期使用芬太尼对术后气管拔管的影响.pdfVIP

· 196· 医学临床研究 2008年2月 第 25卷 第2期 J Clin Res，Feb．2008，Vol 25，№2 · 论著· 全麻手术后期使用芬太尼对术后气管拔管的影响 杨慧芝 何小华 罗春生 唐运林 李孝安 薛鹏 (解放军第458医院，广东 广州 510602) [摘要]【目的】探讨全麻术后使用芬太尼对病人气管拔管的影响。【方法]987例气管插管全身麻醉的手 术病人随机分为对照组(c组， =498)和芬太尼组(F组， =489)。对照组按常规静吸复合全麻，芬太尼组 在手术结束前1 h提前关闭吸入全麻药，改用芬太尼维持麻醉。手术停止后，分别记录每组病人的吞咽反射、 呼吸通气量恢复时间，清醒时间，拔管时间。同时记录病人有无剧烈呛咳、躁动，拔管后有无出现异常呼吸及 拔管时病人的血压、脉搏、呼吸、脉搏氧饱和度。【结果】两组病人一般资料，手术方式差异无显著性。F组病 人拔管时躁动、应激反应的发生率、吞咽反射、呼吸通气量恢复正常的时间，清醒的时间均明显低于对照组(P O．01)，同时拔管的时间也早于对照组(PO．05)，而拔管后出现异常呼吸的发生率无显著性(P0．05)。 【结论】气管插管全身麻醉中，于手术结束前提前关闭吸入麻药，改用芬太尼维持麻醉，能明显减少病人躁动、 应激反应的发生率，同时能缩短病人吞咽反射、呼吸通气量的恢复时间，加快病人的清醒，缩短拔管时间 [关键词] 插管法，气管内； 芬太尼／治疗应用； 麻醉，全身 Effect of Intravenous Fentanyl on Postoperative Extubation in the Later Period of Surgery under General Anesthesia YANG Hui—zhi， HE Xiao-hua， LUO Chun—sheng，et al(Department of A Ps Ps 0Z0g ，the 458th Hospital，PLA，Ouangzhou 510602，C~ina) [Abstract-][Objeetive]To study the security and controllability of tracheal extubation after operation under gen— eral anesthesia．[Methods]Nine hundred and eighty seven patients with ASA physical status I～Ⅱwere randomly di— vided into two groups：control group(C group， =498)and fentanyl group(F group， =489)．Control group were induced by intravenous drugs and maintained by isoflurane and the volatile anesthetic was maintained right up to the end of the procedure．In fentanyl group，patients were changed fentanyl to ma intain anesthesia one hour before the end of operation turning off the vaporizer．After operation，the recovering time of the deglutition reflex and the mi— nute ventilation，the time of awake and tracheal extubation were recorded．The patient s severe chocking cough and restlessness were recorded at extubation simultaneously．Abnormal breathing was recorded after extubation．BP (SBP，DBP，MAP)，HR，RR，Sp02 and EtCOz were recorded immediat