Evaluation of the spontaneous breathing trial in burn intensive care patients

Background

The extubation failure rate in our burn patients is 30%.

Objective

To evaluate the influence of the 30 min spontaneous breathing trial on extubation outcome in burn patients.

Methods

A prospective, observational study in a burn intensive care unit. All adult patients requiring mechanical ventilation for >24 h and meeting the inclusion criteria underwent a 30 min spontaneous breathing trial (SBT). Extubation was undertaken after a successful SBT.

Results

Of 49 planned extubations, 9 failed (18%), much lower than the 30% extubation failure rate identified prior to the implementation of the SBT. The duration of ventilation was significantly shorter (p = 0.04) in the patients who passed a SBT and those who failed extubation were significantly older (p = 0.003). The logistic regression analysis identified that age independently predicted extubation outcome. Patients who failed extubation, after a successful SBT, had a significantly longer duration of ventilation (p = 0.0001) and ITU length of stay (p = 0.001).

Conclusions

The incidence of extubation failure was much lower and the duration of ventilation significantly shorter in patients who were extubated after a successful SBT. These findings support the use of the SBT in burn patients. Age independently predicts extubation outcome in burn patients who have passed a SBT.     

不同时间注射丙泊酚对全麻病人气管拔管反应及麻醉苏醒的影响

目的：探讨不同时间注射丙泊酚对全麻病人气管拔管反应及麻醉苏醒的影响。方法：20～60岁病人120例行腹部手术,ASA分级Ⅰ～Ⅱ级,无肝肾及内分泌系统疾病,随机分为4组,每组30例。Ⅰ组：对照组,满足拔管指征即拔管;Ⅱ组：满足拔管指征,丙泊酚用药后1min拔管;Ⅲ组：满足拔管指征,丙泊酚用药后5min拔管;Ⅳ组：满足拔管指征,丙泊酚用药后10min拔管;监测麻醉诱导前、术毕丙泊酚注射前、拔管时、拔管后5min时心率、血氧饱和度、血压,记录各组拔除气管至清醒对答的时间等情况。结果：气管拔管时Ⅱ组和Ⅲ组心血管反应、躁动明显低于Ⅰ组（P〈0．05）,Ⅲ组清醒时间、低血氧饱和度明显高于Ⅰ组（P〈0．05）,Ⅳ组心血管反应、清醒时间、躁动、清醒时间、低血氧饱和度较Ⅰ组差异无统计学意义（P〉0．05）。结论：全麻病人术毕有拔管指征,立即注射丙泊酚1mg／kg,用药后5min行气管拔管是安全、有效的。     

全麻下鼻窦开放术后拔管期间防止呛咳的研究

目的探讨预防全麻下鼻窦开放术后拔管期间呛咳的方法。方法选取2011年1月~2月于本院进行全麻下鼻窦开放术治疗的140例患者为研究对象,随机分为A组和B组各70例,A组术毕前导管内注入利多卡因,B组术毕前导管内注入丁卡因,后将两组患者呛咳发生率及拔管前5 min、拔管后即刻、拔管后5 min的HR、MAP、SBP、DBP、BIS及血糖、皮质醇、β内啡肽水平进行统计及比较。结果 B组呛咳发生率低于A组,B组HR、MAP、SBP、DBP、BIS及血糖、皮质醇、β内啡肽水平波动幅度均小于A组,P均<0.05,差异均有统计学意义。结论丁卡因在预防全麻下鼻窦开放术后拔管期间呛咳中的效果更好,患者的应激反应更轻。     

麻醉恢复室吸痰对病人血压心率的影响

目的观察全麻后病人在麻酸恢复室(PACU)拔管前后吸痰对病人血压心率的影响,寻找尽量减少对病人刺激的方法,以减少术后并发症的发生。方法收集美国麻醉医师协会麻醉前病情评级(ASA)Ⅰ~Ⅱ级的病人80例,按进入PACU编号随机分成两组,每组40例;实验组:入PACU时立即吸痰,等病人苏醒后立即拔除导管;对照组:病人苏醒后在拔除气管导管前后常规吸痰;观察吸痰前后、拔管前后病人心率、血压变化。结果两组病人在吸痰拔管时血压、心率明显升高,其它各时点血压心率变化差异无显著性意义;但对照组病人吸痰拔管时血压心率明显高于实验组。结论吸痰对苏醒期病人刺激大;深麻醉下吸痰,清醒后立即拔出气管导管能减轻拔管前后心血管反应。