高原地区手术患者全身麻醉的临床处理
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摘要
目的探讨高原地区患者手术全身麻醉管理方法,评价其应用效果。方法对我院2013年7月至2016年7月全身麻醉下手术的76例高原患者,采用随机数字表法分为对照组和观察组,每组患者38例,比较2组患者入室时(T0)、气管插管后(T1)、切皮后30 min(T2)、拔管后30 min(T3)血压(BP)、心率(HR)、脉搏血氧饱和度(SpO_2)及血气指标[p H值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO2)、碱剩余(BE)、血氧饱和度(SaO2)],记录患者术中出入量及术中发生肺水肿及苏醒延迟的例数。结果术中血流动力学观察组比对照组波动小;观察组比对照组的血气指标得到纠正较快,观察组比对照组输液量少,并发症发生率低;观察组苏醒延迟的发生率也低于对照组,差异有统计学意义(P<0.05)。结论肺保护通气策略,目标导向液体管理患者呼吸循环指标,可确保高原地区全身麻醉手术患者安全度过围手术期。
Objective To discuss the clinical management on general anesthesia in surgical patients in plateau area and to evaluate its application effects. Methods Seventy-six patients inplateau-area under general anesthesia in our hospital from July 2013 to July 2016 were selected and randomly divided into control group and observation group, with 38 cases in each group. BP, HR, SpO_2 and blood gas values were compared between the groups at the time of patients entering the room, after tracheal intubation,30 minutes after skin incision and 30 minutes after tube drawing. Intake and output volume, occurrences of pulmonary edema and delayed recovery were recorded afterwards.Results Hemodynamic fluctuations were found smaller in observation group and the abnormal blood gas values were corrected more quickly in this group as well. Furthermore, less fluid infusion, lower rates of complication and delayed recovery were also noted in the observation group. Difference between the two groups was statistically significant(P<0.05). Conclusion Using lung protective ventilation strategy and target-oriented liquid infusion management to regulate respiratory and circulatory indexes can ensure the patients undergoing general anesthesia in plateau area safe in perioperative period.
Objective To discuss the clinical management on general anesthesia in surgical patients in plateau area and to evaluate its application effects. Methods Seventy-six patients inplateau-area under general anesthesia in our hospital from July 2013 to July 2016 were selected and randomly divided into control group and observation group, with 38 cases in each group. BP, HR, SpO_2 and blood gas values were compared between the groups at the time of patients entering the room, after tracheal intubation,30 minutes after skin incision and 30 minutes after tube drawing. Intake and output volume, occurrences of pulmonary edema and delayed recovery were recorded afterwards.Results Hemodynamic fluctuations were found smaller in observation group and the abnormal blood gas values were corrected more quickly in this group as well. Furthermore, less fluid infusion, lower rates of complication and delayed recovery were also noted in the observation group. Difference between the two groups was statistically significant(P<0.05). Conclusion Using lung protective ventilation strategy and target-oriented liquid infusion management to regulate respiratory and circulatory indexes can ensure the patients undergoing general anesthesia in plateau area safe in perioperative period.
引文
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[13]袁东彬,杨武,赖峰,等.不同麻醉方法对老年患者非心脏手术后早期认知的影响[J].中国现代药物应用,2013,7(3):49-50.
[14]刘新伟.全身麻醉和椎管内麻醉对老年骨科手术患者术后精神状态及认知功能的影响[J].山东医药,2012,52(10):47-48.
[15]刘兰.氧疗对高海拔地区老年人术前血压的影响[J].陕西医学杂志,2009,38(4):497.
[16]李富贵,黄秉龙,马成祥,等.高海拔地区老年患者术后认知功能障碍相关因素分析[J].陕西医学杂志,201,46(6):776-777.
[2]刘德生.氧疗对高海拔地区老年人局麻术中高血压的疗效[J].陕西医学杂志,2010,39(12):1692.
[3]王育红,王同猛,尚安云,等.高原地区腹腔镜胆囊切除术CO2气腹对心律的影响[J].临床军医杂志,2009,37(1):48-50.
[4]王国录,刘智明.高海拔地区62例前列腺增生合并高原心脏病的处置经验[J].高原医学杂志,2011,21(4):28-30.
[5]王岩飞,李长山,康敏,等.急性高原病防治问答[M].拉萨:西藏人民出版社,2012:7.
[6]邹在秋,易梅,任用坤,等.拉萨市1024例健康藏汉儿童静脉血红细胞参数正常值参考范围调查[J].高原医学杂志,2000,16(10):22-23.
[7]黄建端,傅玉江.高原实用外科学[M].拉萨:西藏人民出版社,1992:394-396.
[8]于向鸿,赵国香,窦元元.高原地区麻醉体会[J].中国现代医学杂志,2002,12(17):96.
[9]汪悦,李娟,康芳,等.目标导向液体治疗对老年单肺通气患者局部脑氧饱和度及血流动力学的影响[J].临床麻醉学杂志,2017,33(9):837-841.
[10]徐娜,兰飞,姚东旭,等.目标导向液体治疗对脊柱手术老年患者预后的影响[J].临床麻醉学杂志,2018,34(7):647-650.
[11]庄心良,曾因明,陈伯銮,等.现代麻醉学[M].3版.北京:人民军医出版社,2003:1212.
[12]宋瑞凤,程桥,田首元,等.不同全身麻醉方式对老年消化道肿瘤患者手术后早期认知功能的影响[J].中国药物与临床,2012,12(7):870-872.
[13]袁东彬,杨武,赖峰,等.不同麻醉方法对老年患者非心脏手术后早期认知的影响[J].中国现代药物应用,2013,7(3):49-50.
[14]刘新伟.全身麻醉和椎管内麻醉对老年骨科手术患者术后精神状态及认知功能的影响[J].山东医药,2012,52(10):47-48.
[15]刘兰.氧疗对高海拔地区老年人术前血压的影响[J].陕西医学杂志,2009,38(4):497.
[16]李富贵,黄秉龙,马成祥,等.高海拔地区老年患者术后认知功能障碍相关因素分析[J].陕西医学杂志,201,46(6):776-777.