Effects of different deflation modes for endotracheal tube cuff on coughing response and hemodynamics during extubation
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摘要:目的
探讨气管导管套囊不同放气方式对拔管期呛咳反应及血流动力学的影响。
方法选取90例择期气管插管全身麻醉手术患者作为研究对象, 随机分为研究组和对照组, 每组45例。研究组将气管导管套囊的气囊端经三通分别连接注射器和无液压力计, 拔管前抽吸套囊, 使套囊内压下降3 cmH2O/s; 对照组拔管时使用注射器一次性快速抽尽套囊内气体。记录2组患者拔管期呛咳反应发生率及严重程度, 记录全麻诱导前(T0)、套囊放气前(T1)、放气后即刻(T2)、拔管后1 min(T3)、拔管后3 min(T4)、拔管后5 min(T5)时点的平均动脉压(MAP)、心率(HR), 并记录2组患者不良反应发生情况。
结果2组患者拔管期呛咳反应的起始时刻均为气管导管套囊放气即刻; 研究组患者呛咳反应发生率和严重程度均低于对照组, 差异有统计学意义(P < 0.05)。与对照组比较, 研究组T2~T4时点MAP降低, T2~T5时点HR降低, 差异有统计学意义(P < 0.05)。研究组拔管后咽部不适发生率为6.67 %, 低于对照组的26.67 %, 差异有统计学意义(P < 0.05); 2组拔管后通气不足发生率比较, 差异无统计学意义(P>0.05)。
结论以恒定速度缓慢降低气管导管套囊压力的方法可以降低呛咳发生率和严重程度, 减少术后拔管并发症, 稳定血流动力学, 效果优于一次性快速抽尽套囊内气体法。
Abstract:ObjectiveTo investigate the effects of different deflation methods of endotracheal tube cuff on coughing response and hemodynamics during extubation.
MethodsNinety patients undergoing elective surgery for endotracheal intubation under general anesthesia were selected as study subjects and randomly divided into study group and control group, with 45 patients in each group. In the study group, the cuff end of the endotracheal tube cuff was connected to a syringe and a non-liquid pressure gauge through a three-way stopcock. Before extubation, the cuff was aspirated to decrease the cuff pressure at a rate of 3 cmH2O/s. In the control group, the gas in cuff was rapidly deflated by aspirating all the gas inside with a syringe during extubation. The incidence and severity of coughing response during extubation were recorded in both groups. Mean arterial pressure (MAP) and heart rate (HR) were recorded before induction of general anesthesia (T0), before cuff deflation (T1), immediately after cuff deflation (T2), 1 minute after extubation (T3), 3 minutes after extubation (T4), and 5 minutes after extubation (T5). Adverse events were also recorded in both groups.
ResultsThe coughing response during extubation started immediately after cuff deflation in both groups. The incidence and severity of coughing response were lower in the study group than in the control group (P < 0.05). Compared with the control group, values of MAP were lower at T2 to T4 and values of HR were lower at T2 to T5 in the study group (P < 0.05). The incidence of post-extubation pharyngeal discomfort was 6.67 % in the study group, which was lower than 26.67 % in the control group (P < 0.05). There was no significant difference in the incidence of post-extubation hypoventilation between the two groups (P>0.05).
ConclusionThe method of slowly reducing the pressure of the endotracheal tube cuff at a constant rate can reduce the incidence and severity of coughing, decrease postoperative extubation complications, and stabilize hemodynamics, with better effects than the method of rapidly aspirating all the gas inside the cuff at once.
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Keywords:
- endotracheal tube /
- cuff /
- pressure /
- extubation /
- coughing /
- hemodynamics
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表 1 2组患者一般资料和围术期相关指标比较(x±s)[n(%)]
资料 分类 研究组(n=45) 对照组(n=45) 性别 男 21(46.67) 21(46.67) 女 24(53.33) 24(53.33) 年龄/岁 48.53±10.91 47.42±10.80 体质量指数/(kg/m2) 24.76±2.59 24.37±2.64 美国麻醉医师协会分级 Ⅰ级 21(46.67) 23(51.11) Ⅱ级 24(53.33) 22(48.89) 手术类型 普外科手术 22(48.89) 21(46.67) 骨科手术 12(26.67) 12(26.67) 泌尿外科手术 11(24.44) 12(26.67) 手术时间/min 70.56±30.95 64.33±23.76 气管导管留置时间/min 103.00±31.16 92.44±27.75 套囊内压力/cmH2O 插管后 26.07±1.54 25.67±1.51 拔管前 26.07±1.48 25.82±1.21 术中麻醉药物用量 丙泊酚全麻诱导/(mg/kg) 1.59±0.23 1.60±0.30 舒芬太尼/(μg/kg) 0.37±0.08 0.38±0.07 瑞芬太尼/[μg/(kg·min)] 0.12±0.02 0.13±0.04 右美托咪定/[μg/(kg·h)] 0.55±0.22 0.61±0.45 顺阿曲库铵/(mg/kg) 0.14±0.05 0.14±0.05 七氟烷吸入时间/min 38.91±17.72 36.33±13.54 
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表 2 2组患者拔管期呛咳反应情况比较[n(%)][M(P25, P75)]
组别 呛咳反应分级 有呛咳反应 呛咳反应严重程度/级 0级 1级 2级 3级 对照组(n=45) 3(6.67) 12(26.67) 19(42.22) 11(24.44) 30(66.67) 2.00(1.00, 2.50) 研究组(n=45) 16(35.56) 15(33.33) 12(26.67) 2(4.44) 14(31.11)* 1.00(0, 2.00)* 与对照组比较, * P < 0.05。
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表 3 2组患者各时点心率、平均动脉压比较(x±s)
组别 指标 T0 T1 T2 T3 T4 T5 对照组(n=45) 平均动脉压/mmHg 99.58±11.53* 87.87±10.12 106.87±9.62* 105.24±10.71* 101.33±10.30* 95.27±7.70* 心率/min-1 76.27±10.45* 66.04±11.62 87.40±11.06* 84.36±11.54* 79.82±9.74* 76.07±11.17* 研究组(n=45) 平均动脉压/mmHg 99.02±13.26* 89.11±12.52 98.96±12.29*# 96.91±11.59*# 95.04±9.63*# 92.47±9.09 心率/min-1 75.98±7.57* 64.82±9.58 80.29±16.53*# 76.69±14.24*# 72.67±11.71*# 70.53±11.34*# 与T1比较, * P < 0.05; 与对照组比较, #P < 0.05。
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