气管插管拔除对老年冠脉搭桥术患者生命体征影响的研究

目的探讨气管插管拔除对60岁以上冠脉搭桥术（Coronary Artery Bypass Grafting，CABG）患者生命体征主要指标的影响作用，进一步明确对老年患者气管插管拔除前后的护理要点，制定护理计划。方法2004年9月～2005年3月在我院行CABG患者39例，术后入重症监护室（ICU）后予呼吸机支持，当患者病情符合拔管指征时予以拔管，观察记录拔管前后血流动力学参数和动脉血气主要指标值。结果患者拔管后10min的收缩压（SBP）与拔管前显著升高（P〈0．05），拔管后30min与拔管前比较差异无显著性（P〉0．05）；拔管前后的舒张压（DBP）、氧饱和度（SatO2）、中心静脉压（CVP）和肺动脉嵌压（PAwP）比较差异无显著性（P〉0．05）；拔管前后动脉血气分析中pH值、二氧化碳分压（PaCO2）和氧分压（PaO2）与拔管前比较差异无显著性（P〉0．05）。结论气管插管拔除对老年CABG患者的收缩压有短暂的升高作用，应在拔管后加强血压监护，同时做好胸部体疗，预防肺部并发症发生。

Study of the Effect on Vital Signs of Elderly Patients Undergone Coronary Artery Bypass Grafting after Endotracheal Tube Extubation

Objective To study the effect on vital signs of elderly patients over 60-year undergone coronary artery bypass grafting(CABG) after endotracheal tube extubation, to make it clearer the emphasis of nursing in such patients pre- or post-extubation of the endotracheal tube. Methods Thirty-nine elderly in-patients over 60-year undergone CABG from Sept. 2004 to Mar. 2005, were supported with respirator in ICU after operation. The endotracheal tube were extubated when it's indication was fulfilled, and the hemodynamic parameters and arterial blood gas were observed during pre- and post-extubation period. Results The patient' s systolic pressure was elevated significantly at 10 minutes after extubation as compared with pre-extubation, (P < 0.05) , and such difference was not significant until 30 minutes after extubation. There was no difference in diastolic pressure, oxygen saturation, central venous pressure and pulmonary artery loedge preasure comparing pre- and past-extuba-tion time. The same was true in terms of arterial blood gas, such as pH, PaCO2 and PaO2 . Conclusion Intensive blood pressure monitor should be carried out after extubation because of the temporary elevation of systolic pressure after extubation. At the same time, thoracic physical therapy should be given to prevent possible lung complication.