按需吸痰应用于全麻术后气管导管拔除的对照研究

doi:10.3969/j.issn.1000-8535.2022.06.013

摘要/Abstract

摘要： 目的研究麻醉恢复室(PACU)全麻患者气管内吸痰的最佳时机与按需吸痰的可行性。方法选取2021年6月—2021年10月行经口气管插管静吸复合全身麻醉的择期手术患者240例,随机分为A组(拔管前吸痰组)、B组(入室吸痰组)、C组(入室按需吸痰组)3组,每组80例。A组苏醒时拔除导管前常规气道内及口腔吸痰;B组入PACU时提前气道内及口腔吸痰,苏醒时拔除导管,拔管后清理口腔;C组入室后参考吸痰指征评估患者气道分泌物,有吸痰指征患者吸痰,无吸痰指征者不吸痰,苏醒时拔除导管后清理口腔。分别记录患者术后入PACU时、吸痰及拔管后1 min患者的心率、血压、患者因气管刺激引起的呛咳、恶心呕吐及气道痉挛等发生例数,记录躁动评分、术后咽喉痛评分并进行评估。结果 A组与B组比较,每位患者均有吸痰,A组患者心率、血压、血氧饱和度,在吸痰后及拔管后较B组变化幅度大,差异均有统计学意义(P <0.05),气道应激反应方面,C组有20例患者按需吸痰,3组患者均未出现气道痉挛患者,A组有2例患者因拔管时剧烈呛咳引起呕吐,C组呛咳例数低于A组和B组,差异有统计学意义(P <0.05),气道刺激引起的躁动及术后咽喉疼痛C组低于A组,差异有统计学意义(P <0.05)。结论患者在入室时按需吸痰,拔管时不再吸痰,可减少患者的心血管及气道应激反应,减少术后咽痛。

关键词: 按需吸痰, 心血管应激反应, 气道应激反应, 术后咽痛

Abstract: Objective To investigate the best time for endotracheal suction and the feasibility of on-demand suction in general anesthesia patients of post anesthesia care unit (PACU).Methods A total of 240 selective surgical patients who underwent oral endotracheal intubation with general anesthesia from June 2021 to October 2021 were selected.They were randomly divided into group A (sputum suction before extubation),group B (sputum suction in the room),and group C (in-room sputum suction on demand),80 cases in each group.In group A,routine airway and oral sputum suction was performed before removing the catheter when the patients were waking up.Group B had sputum sucked in the airway and mouth before entering the PACU,removed the catheter when waking up,and cleaned the oral cavity after extubation.In group C,the patients were assessed with reference of suction indications after entering the room.Sputum suction was performed for those with indications,but not for those without indications,and the mouth was cleaned after removing the catheter when awaken.Patient's heart rate,blood pressure,coughing,nausea and vomiting and airway spasm caused by tracheal irritation in 1 minute after suction and extubation were recorded after the patients entered the PACU.The tremor score and sore throat score were recorded and analyzed.Results Comparing group A with group B,each patient had sputum suction.The heart rate,blood pressure,and oxygen saturation of group A changed more significantly than group B after sputum suction and extubation (P<0.05).In terms of airway stress response,20 patients in group C needed suction,none in the three groups had airway spasm.Two patients in group A had vomiting due to severe coughing during extubation.The patients of coughing in group C were significantly less than that of group A and group B,respectively (P<0.05).The dysphoria caused by airway stimulation and postoperative throat pain in group C was significantly lower than that of group A (P<0.05).Conclusions The patient on-demand suction when enter the room,and no suction when extubation,can reduce the patient's cardiovascular and airway stress response and reduce postoperative sore throat.

Key words: suction on demand, cardiovascular stress response, airway stress response, postoperative sore throat

韩天福, 张姣, 周玉萍, 刘焕仪. 按需吸痰应用于全麻术后气管导管拔除的对照研究[J]. 广州医药, 2022, 53(6): 61-64.

HAN Tianfu, ZHANG Jiao, ZHOU Yuping, LIU Huanyi. A control study of on-demand sputum suction after removal of general anesthesia tracheal intubation[J]. Guangzhou Medical Journal, 2022, 53(6): 61-64.

参考文献

[1] 袁璐,陈庆红,向利红,等.吸痰时机对麻醉恢复室患者拔管时心血管反应的影响[J].护理学杂志,2018,33(10):56-57.
[2] 辛翠仪,李尉兰.早期吸痰对妇科手术患者全麻拔管期血氧饱和度及心血管应激反应的影响[J].中国现代药物应用,2019,13(19):128-130.
[3] 江志伟,李宁,黎介寿.快速康复外科的概念及临床意义[J].中国实用外科杂志,2007,27(2):131-133.
[4] American Association for Respiratory Care.AARC clinical practice guidelines:endotracheal suctioning of mechanically ventilated patients with artificial airways 2010[J]. Respirat Care,2010,55(6):758-764.
[5] 魏丽丽,韩斌如,王军.机械通气患者按需吸痰的研究进展[J].西南国防医药,2018,28(1):92-94.
[6] 薛鹏扬,高健,周文华,等.机械通气病人人工气道内吸痰护理研究进展[J].护理研究,2019,33(14):2446-2448.
[7] 中华医学会呼吸病学分会呼吸治疗学组.成人气道分泌物的吸引专家共识(草案)[J].中华结核和呼吸杂志,2014,37(11):809-811.
[8] 肖艺敏,李元海,高之心.全麻联合超声引导下椎旁神经阻滞在胸-腹腔镜食管癌根治术中的应用[J].临床麻醉学杂志,2018,34(6):529-533.
[9] 张亚香,夏彩芬,黄侠侠,等.ICU患者经口气管插管术后咽痛分级的影响因素及护理措施[J].国际护理学杂志,2020,39(1):24-27.
[10] 王树欣,韩文军,张丽君.基于循证的气管插管全麻导管拔除管理方案的构建与应用[J].护理学杂志,2017,32(10):41-44.
[11] 陈善桂,张正琴.全麻恢复期患者选择气管拔管时机的探讨[J].临床护理杂志,2012,11(4):45-46.
[12] 邓小明,姚尚龙,于布为,等.《现代麻醉学》再版发行[J].中国卫生人才,2014(9):94-95.
[13] WU M,YIN X,CHEN M,et al.Effects of propofol on intracranial pressure and prognosis in patients with severe brain diseases undergoing endotracheal suctioning[J]. BMC Neurol, 2020,20 (1):394.
[14] 李桂阁,王颖.不同吸痰时机预防全麻拔管心血管反应的临床观察[J].海南医学,2010,21(14):20-21.
[15] 范里莉,王炬,韩旭,等.全麻术后复苏期患者吸痰时机探讨[J].护理学杂志,2009,24(20):7-8.
[16] 张小艳,田思维,范满红.气管插管按时吸痰和按需吸痰的比较[J].中国保健营养,2015,25(16):106.
[17] MELISSA D,JUDY E.An evidence-based evaluation of traeheostomy care practices[J].Crit Care Nurs Q,2008,31(2):150-160.
[18] NAKAHIRA J,NAKANO S,SAWAI T,et al.Factors causing post-anesthetic high respiratory resistance in patients undergoing transurethral resection of bladder tumors[J].Anesth Pain Med,2017,7(2):e44553.
[19] 郭海燕,李思言,刘建梅,等.长托宁和阿托品在全麻患者中的效果对比观察及对认知功能、细胞免疫水平的影响研究[J].中国免疫学杂志,2021,37(3):346-350.
[20] CHEN C Y,KUO C J,LEE Y W,et al.Benzydamine hydrochloride on postoperati-ve sore throat: a meta-analysis of randomized controlled trials[J].Can J Anaesth,2014,61(3):220-228.
[21] 张晓敏,杨宁,彭雅雯,等.成年人全身麻醉气管插管术后咽喉痛防治的研究进展[J].国际麻醉学与复苏志杂,2018,39(9):900-904.
[22] 王鸽.呼吸过滤器在新型冠状病毒肺炎疫情防控期间的应用效果[J].当代护士,2021,28(6):封3.