非胸腹部手术拔管时右侧膈肌运动的超声评价

目的 探讨应用床旁超声测量非胸腹部手术全身麻醉术后达到临床拔管指征时右侧膈肌运动幅度的临床效果. 方法 采用随机数字表法选择接受非胸腹部手术全身麻醉患者110例,分为男性组(56例)和女性组(54例),术前使用M型超声记录患者平静呼吸时膈肌运动幅度.术中依据HR、BP等调整用药,维持麻醉深度,手术结束前30 min停止追加肌肉松弛药,手术结束后患者进入PACU,使用2～5 MHz超声探头,右锁骨中线肋缘下以肝为声窗,用M型超声记录达到临床拔管指征平静呼吸时的膈肌运动幅度,拔管后10、30 min平静呼吸时膈肌运动幅度,并记录拔管时间、拔管时Ramsay镇静评分,患者持续抬头5s时间. 结果 与麻醉前男(16.8±2.6) mm,女(14.6±1.6) mm]比较,拔管时男(13.1±1.4) mm,女(12.4±1.2)mm]两组膈肌运动幅度差异有统计学意义(P＜0.05),拔管后10 min男(15.7±2.7) mm,女(13.9±2.1) mm]、30 min男(16.1±2.6) mm,女(14.3±2.0) mm]两组膈肌运动幅度差异均无统计学意义(P＞0.05);与拔管时比较,拔管后10、30 min两组膈肌运动幅度差异有统计学意义(P＜0.05);拔管后10 min与拔管后30 min比较,两组膈肌运动幅度差异无统计学意义(P＞0.05).两组拔管时间、Ramsay镇静评分、持续抬头5s时间比较,差异无统计学意义(P＞0.05). 结论 超声测量右侧膈肌运动有较高的可操作性和可重复性,在PACU对于评价麻醉恢复期膈肌功能的恢复具有可行性.

The movement of right side of the diaphragm assessed by ultrasonography in patients with non thoracic and abdominal surgery at postanesthesia

Objective To detect the fight diaphragmatic motion of the patients with non thoracic abdominal surgery by using M-mode ultrasound in PACU and to get motion amplitude value when performing extubation.Methods The study enrolled 110 patients of whom 56 were male and 54 female with non-thoracic and abdominal surgery in the PACU who required extubation.Diaphragmatic movement was measured by a single well-trained doctor with a 2-5 MHz US probe placed over one of the lower intercostal spaces in the right anterior axillary line for the right diaphragm using an Esaote ultrasound machine before the anesthesia and during extubation as well as 10 and 30 mins after extubation.The liver was used as a window for right hemidiaphragm with the patient supine.The time ranges from muscle relaxants stopped to extubation,from muscle relaxants stopped to who could raise head for 5 s was recorded.And Ramsay score were recorded before the movement of extubation.Results Compared with those before anesthesia male (16.8±2.6) mm,female (14.6±1.6) mm],extubation male (13.1±1.4) mm,female (12.4±1.2) mm] was statistically significant in two groups of diaphragm motion amplitude difference (P＜0.05),10 minmale(15.7±2.7) mm,female(13.9±2.1) mm],30 minmale(16.1±2.6) mm,female(14.3±2.0) mm] after extubation in two groups of diaphragm motion amplitude showed no significant difference(P＞0.05).Compared with extubation,there was statistical significance after extubation in 10,30 min two group of diaphragm the motion amplitude difference (P＜0.05).10 min after extubation and 30 min after extubation comparison,no statistically significant difference between the two groups of diaphragm motion amplitude (P＞0.05).There is no Statistical significance between preoperative and being out of PACU.Conclusions The fact that M-mode ultrasound measures the right diaphragmatic motion range when performing extubation has higher operability and repeatability to evaluate the functional recovery of the diaphragm in PACU.