Airtraq光学可视喉镜与直接喉镜在急诊气管插管中的应用

【目的】探讨Airtraq光学可视喉镜与Macintish直接喉镜在急诊气管插管患者中的应用价值。【方法】本院急诊气管插管患者80例,随机分为两组,各40例。A组采用Airtraq光学可视喉镜气管插管,M组采用Macintish直接喉镜气管插管。比较两组插管相关情况;记录比较两组麻醉诱导前（T0）、气管插管前（T1）、插管后即刻（T2）、插管后1min（T3）、插管后3min（T4）时收缩压（SBP）、舒张压（DBP）、心率（HR）、心率收缩压乘积（RPP）变化,T0、T4时点肾上腺素（E）、去甲肾上腺素（NE）水平。【结果】A组声门显露时间长于M组,气管插管次数少于M组,且两组相比较差异有显著性（P〈0．05）;A组1次插管成功率为95．0％（38／40）,高于M组75．0％（30／40）（P〈0．05）;两组总气管插管时间相比较差异无显著性（P〉0．05）。A组T2时DBP、HR低于M组,T2～T3时RPP低于M组（P〈0．05）;A组T4时E、NE水平低于M组（P〈01．05）;A组气管插管后不良反应及并发症发生率为7．5％（3／40）,明显低于M组的27．5％（11／40）,且差异有显著性（P〈0．05）。【结论】Airtraq光学可视喉镜可提高急诊气管插管患者1次插管成功率,减少插管应激反应,但插管时间与Macintish直接喉镜气管无异。     

右美托咪定对老年高血压患者围术期心肌的保护作用

目的观察右美托咪定对老年高血压患者围术期心肌的保护作用。方法择期行全髋置换手术的老年高血压患者30例,年龄〉65岁,高血压Ⅱ级,随机分为右美托咪定（D组）和对照组（c组）,每组15例。两组均采用静吸复合全身麻醉,诱导方式相同,D组在麻醉诱导前给予负荷剂量右美托咪定1μg／kg,注射泵缓慢静脉注射,输注时间超过10min,维持剂量以0．7μg／（kg·h）持续静脉注射。记录麻醉前、诱导后、气管插管后、拔管后即刻患者的血流动力学变化,同时在麻醉前、气管插管后、拔除气管导管后即刻三个时点记录患者心电图ST段水平。结果两组患者麻醉诱导后心率、血压均明显下降（P〈0．05或P〈0．01）;气管插管后、拔除气管导管后即刻,心率、收缩压、舒张压D组明显低于C组（P〈0．05）;气管插管后、拔除气管导管后即刻,ST段出现心肌缺血性改变,C组5例明显多于D组1例（P〈0．05）。结论静脉注射右美托咪定,能减轻老年高血压患者围术期心肌损伤,对心肌有一定保护作用。     

心脏瓣膜置换术后早期拔除气管插管的护理观察

目的探讨早期拔除气管插管对心脏瓣膜置换术后患者预后的影响。方法选择择期心脏瓣膜置换手术患者60例,以术后气管插管拔管时间8h为分界线,分为观察组和对照组。结果观察组与对照组的平均机械通气时间、ICU停留时间、术后住院时间比较差异均有显著意义（P〈0．05）;而两组的动脉血气分析和血流动力学比较差异无显著意义（P〉0．05）。结论心脏瓣膜置换术后实施早期拔除气管插管,可促进患者的早期康复,减少护理工作量。     

术前应用盐酸戊乙奎醚对老年患者经口气管插管血流动力学的影响

目的观察全身麻醉前应用盐酸戊乙奎醚及阿托品对老年患者经口明视气管插管血流动力学的影响。方法择期全身麻醉下行腹部手术老年患者60例,随机分为阿托品组和戊乙奎醚组各30例,分别于术前30min静脉注射阿托品0．01mg／kg、盐酸戊乙奎醚0．01mg／kg,2组麻醉诱导均按顺序静脉注射咪唑安定0．05rng／kg、芬太尼3μg／kg、阿曲库铵0．8mg／kg、异丙酚1～1．5mg／kg,3min后待患者意识完全消失,实施经口明视下气管插管。记录2组给药前（T0）、麻醉诱导前（T1）、麻醉诱导后（T2）、气管插管即刻（T3）、气管插管后5min（Ta）的血压、心率、脉搏血氧饱和度,计算心率一血压乘积,并比较2组气管插管时间。结果戊乙奎醚组、阿托品组气管插管时间分别为（41．5±11．2）、（39．7±10．3）S,2组比较差异无统计学意义（P〉0．05）;手术过程中2组脉搏血氧饱和度均〉99％,各时间点血压比较差异无统计学意义（P〉0．05）,阿托品组T1～T4时间点心率均较T0明显增快（P〈0．05）,且T1～T3时间点心率、心率一血压乘积高于戊乙奎醚组（P〈0．05）;戊乙奎醚组心率〉100次／min比例低于阿托品组（P〈0．05）。结论老年患者术前应用盐酸戊乙奎醚有利于气管插管时血流动力学的稳定。     

术前应用6%羟乙基淀粉行急性高容量血液稀释对老年患者动脉压及氧代谢的影响

目的：探讨应用6％羟乙基淀粉行急性高容量血液稀释（AHH）对老年患者动脉压和氧代谢的影响。方法：随机选择腹部择期手术的老年患者40例,随机分为两组,A组为高容量血液稀释组,B组为非血液稀释组。B组入室后补充基础生理需要量及禁食丧失需要量。A组患者以25ml／min的速率输入6％羟乙基淀粉7ml／kg后诱导,同时继续输入达15ml／kg行高容量血液稀释,分别监测记录基础值（T0）、诱导后插管前（T1）、插管后即刻（T2）、插管后5min（T3）、10min（T4）、20min（T5）、切皮前（L6）的平均动脉压（MAP）、心率（HR）、中心静脉压（CVP）。经桡动脉取血测血气、Lac。结果：A组患者诱导前后MAP无显著性差异（P〉0．05）,B组诱导后MAP显著降低（P〈0．05）。与同时相A组比较有显著性差异（P〈0．05）。A组CVP插管后5min（T3）与基础值（T0）比较有显著性差异（P〈0．05）。与同时相B组比较有显著性差异（P〈0．05）,两组患者HR诱导后减慢（P〈0．05）。A组血红蛋白（Hb）、细胞压积（Hct）在血液稀释后显著降低（P〈0．05）。两组血气、Lac在血液稀释前后无显著性变化（P〉0．05）。结论：适度AHH有利于维持老年患者血液动力学的稳定,而氧代谢改变不明显,值得临床推广。     

氯胺酮联合曲马多术后镇痛在腹腔镜宫外孕手术中的应用

【目的】比较术前单应氯胺酮与术前应用氯胺酮复合术中应用曲马多对腹腔镜宫外孕病灶清除术术后的镇痛效果差异,为临床术后镇痛提供理论与方法的指导。【方法】选取气管插管静吸复合全身麻醉下施行腹腔镜宫外孕病灶清除手术患者120例,随机分成3组,每组40例,各组病人在麻醉诱导气管插管前均给予地塞米松40μg／kg,静脉诱导并行气管插管。A组为生理盐水对照组,手术开始前和手术结束前20min分剐静脉推注生理盐水2mL;B组于气管插管后手术开始前10min静脉推注氯胺酮2mg／kg,并于手术结束前20min静脉推注生理盐水2mL;C组于气管插管后手术开始前10min静脉推注氯胺酮2mg／kg,并于手术结束前20min静脉推注曲马多2mg／kg。观察各组气管拔管时间,术后4h、12h、24h镇痛评分（VAS）,术后止痛药使用人次。【结果】术后拔管时间三组间之间差异没有统计学意义（P〉0．05）。4个时间点的VAS评分,C组较A、B组明显降低,差异有统计学意义（P〈0．05）;B组和A组之间差异无统计学意义（P〉0．05）。各时间点术后止痛药使用人次,B组与A组比较差异没有统计学意义（P〉0．05）;C组与A组、B组之间比较差异有统计学意义（P〈0．05）。【结论】术前应用氯胺酮复合术中应用曲马多则可显著提高腹腔镜宫外孕病灶清除术的术后镇痛效果。     

喉罩与气管插管用于全麻腹腔镜卵巢囊肿切除手术的比较

目的探讨喉罩全麻在腹腔镜卵巢囊肿切除手术中应用的可行性和安全性。方法选择ASAⅠ～Ⅱ级腹腔镜卵巢囊肿切除手术100例,随机分为两组,每组50例．Ⅰ组为喉罩全麻组（L组）,Ⅱ组为气管插管组（T组）,监测记录插管前后心率（nR）,平均动脉压（MAP）,插管后1min,气腹前1min,气腹后5min,气腹后15min的呼气末C02分压（PETCO2）,气道压力（Paw）,记录术后咽喉痛等并发症的发生例数。结果喉罩组在置入喉罩前后HR,MAP无明显变化。而气管插管组,插管后HR,MAP明显高于插管前（P〈0．05）。两组气腹后PETCO2Paw均较气腹前显著升高,但两组间比较差异无统计学意义（P〉0．05）。喉罩组患者苏醒期躁动、呛咳及术后咽喉痛等并发症明显少于气管插管组（P〈0．05）。结论腹腔镜卵巢切除手术中喉罩全麻具有安全性好,血流动力学平稳,并发症少的优点。     

双管喉罩通气麻醉在老年人侧卧位手术中的临床研究

目的观察间歇正压（IPPV）通气下双管喉罩通气麻醉在老年人侧卧位手术中应用的安全性、有效性。方法选择侧卧位行全髋关节置术患者60例,ASA1Ⅰ～Ⅲ级,年龄〉60岁,随机分为双管喉罩组（P组,30例）和气管插管组（T组,30例）。记录进入手术室连接监测5min后（T0）、插管前即刻（T1）、插管后即刻（T2）、插管后3min（T3）、拔管时（T4）和拔管后5min（T4）的MBP和HR,两组侧卧位正压通气10min（Ta）、手术开始后60min（Th）、术毕（Tc）时的分钟通气量（MV）、潮气量（VT）、气道峰压（Pmax）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）;两组拔管期的不良反应及术后并发症。结果P组插管后即刻（T2）及拔管时（T4）的HR、MBP均较T组降低（P〈0．05）;两组分钟通气量（MV）、潮气量（VT）、气道峰压（Pmax）、脉搏氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）比较差异无统计学意义（P〉0．05）。拔管期呛咳和体动发生率T组明显高于P组,差异有显著性（P〈0．01）,T组术后咽喉痛发生率高（P〈0．05）。结论本观察显示双管喉罩通气全麻可以达到与气管插管一样满意的通气效果,且双管喉罩组插管期和拔管期心血管应激反应更小,拔管期呛咳发生率明显降低。     

右美托咪定持续输注对老年胃肠手术患者血流动力学麻醉药用量及术后苏醒的影响

目的：探讨右美托咪定持续输注对接受胃肠手术治疗老年患者血流动力学、麻醉药用量及术后苏醒的影响。方法将90例行胃肠手术治疗的老年患者按随机数字表法分为观察组和对照组，每组45例，两组均予以常规麻醉，观察组经静脉持续输注右美托咪定，对照组经静脉持续输注等容量的0．9％氯化钠溶液。观察两组手术不同时点血流动力学、麻醉药用量及术后苏醒时间的变化。结果气管插管时、切皮时以及拔管时，两组平均动脉压水平比较差异有极显著性（P＜0．01）；药液持续输注结束时、气管插管时、气管插管后3 min、切皮时以及拔管时，两组心率比较差异有显著性（ P＜0．05或0．01）。观察组应用麻醉药瑞芬太尼、丙泊酚剂量显著低于对照组（P＜0．01），术后苏醒时间与对照组比较差异无显著性（P＞0．05）；插管后、拔管时的平均动脉压、心率均显著低于对照组（ P＜0．01）；脑电双频谱指数60、脑电双频谱指数70、脑电双频谱指数80、睁眼时间均显著长于对照组（ P＜0．05或0．01）。结论对接受胃肠手术治疗的老年患者予以右美托咪定持续输注，可减少麻醉用药剂量，有利于患者血流动力学的稳定，且不影响患者的苏醒时间，值得临床推广应用。     

星状神经节阻滞（SGB）对气管插管心血管反应的影响

目的观察星状神经节阻滞（SGB）对气管插管期间心血管反应的影响。方法选择60例全麻手术病人,随机分为星状神经节阻滞组（G组）,对照组（D组）,分别测定插管前、插管即刻、插管后1、3、5min的收缩压（SBP）、舒张压（DBP）、心率和收缩压乘积（RPP）变化。结果G组病人插管前、插管后及1、3、5rainSBP、DBP、HR、RPP变化与插管前比较,差异无统计学意义（P〉0．05）,而D组插管后各参数较插管前明显上升,差异有统计学意义（P〈0．01）。结论星状神经节阻滞（SGB）能明显抑制全麻气管插管的心血管反应。     

Pediatric extubation readiness tests should not use pressure support

Purpose

Pressure support is often used for extubation readiness testing, to overcome perceived imposed work of breathing from endotracheal tubes. We sought to determine whether effort of breathing on continuous positive airway pressure (CPAP) of 5 cmH₂O is higher than post-extubation effort, and if this is confounded by endotracheal tube size or post-extubation noninvasive respiratory support.

Methods

Prospective trial in intubated children. Using esophageal manometry we compared effort of breathing with pressure rate product under four conditions: pressure support 10/5 cmH₂O, CPAP 5 cmH₂O (CPAP), and spontaneous breathing 5 and 60 min post-extubation. Subgroup analysis excluded post-extubation upper airway obstruction (UAO) and stratified by endotracheal tube size and post-extubation noninvasive respiratory support.

Results

We included 409 children. Pressure rate product on pressure support [100 (IQR 60, 175)] was lower than CPAP [200 (120, 300)], which was lower than 5 min [300 (150, 500)] and 60 min [255 (175, 400)] post-extubation (all p < 0.01). Excluding 107 patients with post-extubation UAO (where pressure rate product after extubation is expected to be higher), pressure support still underestimated post-extubation effort by 126–147 %, and CPAP underestimated post-extubation effort by 17–25 %. For all endotracheal tube subgroups, ≤3.5 mmID (n = 152), 4–4.5 mmID (n = 102), and ≥5.0 mmID (n = 48), pressure rate product on pressure support was lower than CPAP and post-extubation (all p < 0.0001), while CPAP pressure rate product was not different from post-extubation (all p < 0.05). These findings were similar for patients extubated to noninvasive respiratory support, where pressure rate product on pressure support before extubation was significantly lower than pressure rate product post-extubation on noninvasive respiratory support (p < 0.0001, n = 81).

Conclusions

Regardless of endotracheal tube size, pressure support during extubation readiness tests significantly underestimates post-extubation effort of breathing.

     

密闭式吸痰对急性呼吸窘迫综合征小猪呼吸及循环系统的影响

[目的]探讨密闭式吸痰对急性呼吸窘迫综合征(ARDS)小猪动脉血气、呼吸力学和心率(HR)、血压的影响。[方法]先制作小猪ARDS模型,模型成功后将其随机分为呼气末正压(PEEP)5cmH2O组和10cmH2O组,予机械通气30min后进行密闭式吸痰。监测吸痰前1min及吸痰后1min、3min、5min、10min动脉血气、呼吸力学及HR、血压的变化。[结果]两组在密闭式吸痰后动脉血氧分压(PaO2)和动脉血氧饱和度(SaO2)均下降,直到吸痰后10min仍低于吸痰前基线水平(P<0.05),而吸痰后舒张压(DBP)与吸痰前比较均无差异(P>0.05);在PEEP5cmH2O组,吸痰后气道峰压(Ppeak)、平台压(Pplat)、平均气道压(Pmean)均升高,持续到吸痰后10min仍显著高于吸痰前基线水平(P<0.05);肺静态顺应性(Cs)、平均动脉压(MAP)、收缩压(SBP)均降低,持续到吸痰后10min仍低于吸痰前基线水平(P<0.05);在PEEP10cmH2O组,吸痰后1min及3minPpeak显著升高(P<0.05),持续到吸痰后10min仍高于吸痰前基线水平但差异无统计学意义(P>0.05);Pplat、Pmean在吸痰后1min显著增高,在吸痰后3min、5min、10min仍高于吸痰前基线水平但无统计学差异(P>0.05),同时在吸痰后1min及3minCs显著下降(P<0.05),持续到吸痰后10min仍低于吸痰前基线水平但差异无统计学意义(P>0.05)。[结论]不论在PEEP5cmH2O还是10cmH2O水平,密闭式吸痰可引起ARDS小猪较严重的低氧血症,使气道压力增高、肺顺应性降低、血压下降。但在PEEP5cmH2O组,吸痰所引起的缺氧、气道高压及低血压持续时间较长。     

喉罩应用于老年高血压患者腹腔镜胆囊切除术的麻醉效果与安全性评价

目的观察一次性喉罩（Laryngeal mask airway,LMA）应用于老年高血压患者的麻醉效果与安全性。方法选择择期行腹腔镜胆囊切除术的老年高血压患者80例,ASAⅠ~Ⅱ级,分为喉罩组（A组）和气管内插管组（B组）各40例,观察记录两组患者诱导前5分钟（T0）、插管或置入喉罩后即刻（T1）、插管或置入喉罩后5分钟（T2）、气腹后（T3）、拔管或拔出喉罩时（T4）、拔管或拔出喉罩后5分钟（T5）,6个时间点的心率（HR）、收缩压（SBP）、舒张压（DBP）、心率与收缩压的乘积（RPP）、脉搏血氧饱和度（SpO2）、并观察插管或置入喉罩时、拔除前后及术中相关并发症,记录术后口咽痛、痰多或呛咳发生率。结果 T0时点两组患者HR、SBP、DBP、RPP及SpO2比较差异无统计学意义（P〉0.05）,T1与T4时点B组循环系统应急反应强于A组;两组T2与T3时点的HR、SBP、DBP、RPP比较差异有统计学意义（P〈0.05）;围术期A组呛咳、喉痉挛、术后咽痛、痰多等并发症少于B组（P〈0.05）。结论喉罩较支气管内插管全麻围手术期循环功能更加稳定,插管及拔管时呛咳、喉痉挛、术后咽痛、多痰等并发症更低。     

无创正压通气对心外科术后呼吸困难患者的应用研究

目的研究无创正压通气（NPPV）用于心外科体外循环术后呼吸困难的价值。方法对2004年12月-2006年12月本院心外科体外循环术后部分患者在拔管后发生呼吸困难（呼吸频率〉25次/min及三凹征）或急性呼吸衰竭时,随机用NPPV或面罩吸氧两种方法对患者进行呼吸支持,NPPV组30例,面罩吸氧组28例。两组患者在治疗效果差、仍缺氧〔动脉血氧分压（PaO2）〈60mmHg（1mmHg=0.133kPa）〕,或出现严重室性心律失常及其他气管插管指征时,则予以再次气管插管行有创机械通气。结果两组年龄、急性生理学与慢性健康状况评分系统（APACHE）评分、体外循环时间、主动脉阻断时间、术前纽约心功能分级等一般情况比较差异均无显著性（P均〉0.05）。与面罩吸氧组比较,NPPV组治疗120min后心律失常发生率、需气管插管率、住重症加强治疗病房（ICU）天数、ICU病死率均显著下降（P〈0.05或P〈0.01）。与0min时比较,两组pH于480min时明显上升（P均〈0.05）;PaCO2于120min起开始上升（P均〈0.05）,480min时明显上升（P均〈0.01）。与0min时比较,NPPV组于30min起PaO2、HCO3-显著升高,呼吸频率、心率、动脉收缩压显著下降,差异均有显著性（P〈0.05或P〈0.01）;而面罩吸氧组PaO2、HCO-3、呼吸频率、心率、动脉收缩压分别于120、60、120、480和480min开始出现显著性差异（P〈0.05或P〈0.01）。与0min时比较,NPPV组乳酸于60min起开始出现下降,差异有显著性（P〈0.05）;而面罩吸氧组则于480min时才开始出现下降,差异有显著性（P〈0.05）。结论NPPV是解决心外科术后呼吸困难、急性呼吸衰竭的一种安全、有效方法,在选择性心外科手术后患者中积极使用NPPV可明显缓解呼吸困难,改善组织灌注,减少术后心律失常的发生,降低术后再插管的需要,缩短住ICU时间,降低病死率。     

High frequency jet ventilation — its use in respiratory insufficiency

High frequency jet ventilation was used in two patients with severe pulmonary disease, one of whom was deteriorating and the other not improving on a conventional regime of antibiotics, physiotherapy and intermittent positive pressure ventilation. In our first case high frequency jet ventilation was achieved using one side of a double lumen endotracheal tube, whilst intermittent positive pressure ventilation was applied to the other side. In the second case a specially designed endotracheal tube with a distal jetting orifice was employed. In both cases there was marked improvement in chest X-ray appearence, arterial blood gas analysis and clinical condition, permitting resumption of sponteneous ventilation, extubation and eventual discharge from the Intensive Therapy Unit.     

手汗症患者电视纵隔镜下胸交感神经切断术的麻醉处理

目的 探讨电视纵隔镜行T2～T4交感神经切断术治疗手汗症的麻醉管理.方法 150例手汗症患者随机分为3组,每组50例.分别选择双腔管(A组)、单腔管低潮气量机械通气组(B组)和单腔管暂停机械通气组(C组)插管静脉吸入复合全身麻醉,连续监测呼气末二氧化碳分压、脉搏氧饱和度、有创动脉压、心电图,于插管前、插管后5min、切断交感神经即刻、膨肺维持气道正压时、术毕即刻等时点记录上述参数的变化,同时抽取动脉血行血气分析.结果 与术前比较,各组患者切断双侧胸交感神经后心率减慢(P ＜0.05);膨肺维持正压时血压明显下降(P＜0.05);B、C两组患者于切断胸交感神经即刻PaCO2明显升高,但术毕恢复正常.结论 应用电视纵隔镜行胸交感神经切断术治疗手汗症,使用单腔或双腔气管插管静脉吸入复合全身麻醉均安全可行,且使用单腔管插管技术简单、费用低及术后并发症无明显增加.     

Fewer interventions in the immediate post-extubation management of pediatric intensive care unit patients: Safety and cost containment

: The purpose of this article was to compare the safety and patient charges of two postextubation treatment regimens.

: Twenty-two pediatric patients, between the ages of 7 months and 13 years, who were mechanically ventilated for less than 5 days were studied in a prospective randomized nonblinded study at a multidisciplinary pediatric intensive care unit. Immediately after extubation all patients received supplemental oxygen, administered via mask or nasal cannulae, at a flow rate or concentration sufficient to maintain the pulse oximetric arterial oxygen saturations>95%; arterial blood gas analyses were performed at 30 minutes after extubation. The subjects were randomly assigned to one of two protocols. Protocol A (our standard management) consisted of (1) three nebulized albuterol treatments administered 1 hour apart, and (2) a chest radiograph obtained within 60 minutes of extubation. Protocol B included one nebulized albuterol treatment administered immediately after extubation. We measured the heart rate, respiratory rate, and arterial blood pressure immediately after and at 60, 120, and 180 minutes following extubation. The following data were also recorded: arterial blood gas analysis results and continuous pulse oximetric arterial oxygen saturation levels. Any significant complications, such as stridor, respiratory distress, or requirement for reintubation, were noted if they occurred within 24 hours of extubation. Patient charge costs were calculated after obtaining the prevailing hospital and physician charges at the time of the study.

: Eleven patients completed each arm of the study (total = 22). There were no statistically significant differences between the two groups with respect to arterial pH, serum bicarbonate, pulse oximetric arterial oxygen saturation, arterial blood pressure, respiratory rate, or heart rate (P> .05). Patients treated with Protocol A had a statistically, but not clinically, significant higher mean Pa ₂ and Pa ₂ (P = .02 and P = .05, respectively) than those in Protocol B. Associated charges per patient for Protocol A were $863.50 versus $476.00 for Protocol B. This is a savings of $387.50 per patient. Our pediatric intensive care unit provides care to over 600 intubated patients per year, which would equate to a charge savings of $232,500.00 per year.

: A modified postextubation management protocol, consisting of fewer interventions, resulted in significant patient charge savings with no increased risk to the patient.     

正压通气拔管法对心内直视术后患者动脉血气指标的影响

目的 探讨正压通气拔除气管插管(简称拔管)对心内直视术后患者动脉血气分析指标的影响.方法 将50例行心内直视术后经口气管插管的患者,随机分为对照组和实验组各25例.对照组采用传统拔管法,实验组则采取在患者吸气期给予5～25 cm H2O纯氧正压通气,于呼气期拔管.比较2组患者拔管前、拔管后l,5,10 min的PaO2、PaCO2、SaO2、动脉血pH值和RR变化,同时观察拔管期间呼吸道梗阻情况.结果 拔管后2组患者动脉血气分析指标在各对应时点进行比较,实验组变化的幅度明显低于对照组,且变化的持续时间缩短50%以上.拔管后对照组发生呼吸道梗阻4例,实验组未发生呼吸道梗阻,2组比较有明显差异.结论 正压通气拔管法能提高肺顺应性,改善氧合,使患者拔管后各项动脉血气分析指标较为平稳,降低低氧血症的发生率,是一种比较安全的拔管方法.

Abstract：

Objective To study the effect of positive pressure ventilation extubation on arterial blood gas indexes of patients undergoing cardiac surgery. Methods 50 patients with orotracheal intubation after intracardiac opening operation under direct vision were randomly divided into the control group and the experimental group with 25 cases in each group. We used traditional method to pull out tracheal intubation in the control group. And positive pressure ventilation at 5 ～15 cm H2O during inspiration and pulling out tracheal intubation during expiration in the experimental group. The change of arterial blood PaO2, PaCO2, SaO2, pH and respiratory rate before and 1min、5min、10min after extubation was observed,and also the incidence rate of air tube obstruction was recorded. Results The change amplitude of arterial blood gas indexes of patients in the experimental group was obviously lower,and the length of change time reduced more than 50%. There were 4 air tube obstructions in the control group and there was no obstruction in the experimental group. The difference was statistically significant. Conclusions Positive pressure ventilation extubation can raise lung's compliance and improve oxygenation. And arterial blood gas indexes are more stable. It can decrease the incidence rate of hypoxemia and is a much more safe method.     

Improvement in accuracy of transcutaneous measurement of oxygen with resumption of spontaneous ventilation in mechanically ventilated patients after off pump coronary artery bypass procedure: a prospective study

Introduction  

Transcutaneous measurement of gases depends on the degree of skin perfusion. Mechanical ventilation causes alteration in the peripheral perfusion. The aim of this prospective observational study was to assess change in the accuracy of interchangeability of arterial blood gases with those obtained transcutaneously at various phases of mechanical ventilation such as controlled mandatory, synchronized intermittent mandatory, continuous positive airway pressure ventilations, spontaneous breathing trail and spontaneous ventilation after extubation of endotracheal tube.     

Factors promoting successful extubation: An audit of planned extubations in preterm infants following the implementation of nursing guidelines

Reintubation, following an unsuccessful extubation from mechanical ventilation is traumatic for the infant and the family. This paper examines the increased success rate of extubations in one tertiary unit following the introduction of nursing guidelines for extubation. In the sample of 19 babies, 17 remained extubated for more than 48 h. The discussions within this paper will examine factors such as the mode of ventilation that the babies were on prior to extubation, the timing of handling pre and post-extubation and the position that they were nursed in after removal of the endotracheal tube. There is also discussion around areas where the nursing guidelines were not adhered to, and the reasons as to why this might be. The conclusion though is that there is some tentative evidence to support the use of nursing guidelines to improve outcomes for infants, although this is based on a small study.