【摘要】 目的评价间歇通气呼吸暂停麻醉法在输尿管软镜钬激光碎石术中的安全性与有效性。方法选择气管内插管全身麻醉下输尿管软镜钬激光碎石术患者30例。随机分为A、B两组,A组为常规潮气量组(10mL/kg);B组为间歇通气呼吸暂停组,呼吸暂停时间为3 min,根据手术需要行呼吸暂停,呼吸暂停次数为5次。观察记录两组患者麻醉前(Ta)、手术开始前(T0)、拔出气管导管时(Tb)及B组患者第1次呼吸暂停3 min后(T1)、第2次呼吸暂停3 min后(T2)、第3次呼吸暂停3 min后(T3)、第4次呼吸暂停3 min后(T4)、第5次呼吸暂停3 min后(T5)各个时间点的心率、血压、pH、PaCO2;同时观察两组患者的拔管时间、定向力恢复时间。结果两组患者Ta、T0、Tb时间点的心率、血压、pH、PaCO2差异无显著性(P>0.05);B组患者T0、T1~T5各个时间点的心率、血压差异均无显著性(P>0.05);两组患者的拔管时间、定向力恢复时间比较差异无显著性(P>0.05)。B组患者T1~T5各个时间点pH值较T0比较有所下降(P<0.05),至Tb时间点时PH回升接近正常水平;B组患者T1~T5各个时间点PaCO2值较T0比较升高(P<0.05),至Tb时间点下降接近正常水平。结论间歇通气呼吸暂停麻醉法可安全、有效地应用于输尿管软镜钬激光碎石术。更多还原

【Abstract】 【Objective】To research the application of apneic anesthesia with intermittent ventilation in holmium laser lithoclasty with flexible ureteroscope. 【Methods】Thirty ASAⅠ~Ⅱpatients undergoing holmium laser lithoclasty with flexible ureteroscope were randomly divided into tow groups. In group A, the tidal volume was 10 mL/kg;in group B, the apneic anesthesia with intermittent ventilation was used, the apnea timing was 3 minutes, the apnea interval time was based on the requirement of operation, and the times of apnea was 5. The following index was recorded including HR, MBP, pH, PaCO2at Ta(pre-anesthesia), T0(preoperation), Tb(tracheal extubation) in both two groups at T1(end of the first apnea), T2(end of the second apnea), T3(end of the third apnea), T4(end of the fourth apnea), T5(end of the fifth apnea) in group B. Then the times of tracheal extubation and orientation recovery after the surgery in two groups were recorded. 【Results】There were no statistically significant differences of HR,时段 组别 HR(/次 /min) MBP/mmHg pH PaCO2/mmHg Ta A 组 69.80±7.89 87.00±7.88 7.37±0.02 41.47±2.13 MBP, pH, PaCO2 at Ta(pre-anesthesia), T0(preoperation), Tb(tracheal extubation) between the two groups(P > 0.05); and there were no statistically significant differences of tracheal extubation time and orientation recovery time(P >0.05). In group B, the pH was lower at T1~T5 than at T0(P <0.05), but the pH raised closing to the normal level at Tb; and the PaCO2 was higher at T1~T5 than at T0(P <0.05), but the PaCO2 declined closing to the normal level at Tb. 【Conclusion】The apneic anesthesia with intermittent ventilation can be applied safely and efficiency during anaesthesia in holmium laser lithoclasty with flexible ureteroscope.更多还原