口腔颌面部全麻手术患者安置胃管时机的探讨

目的 探讨口腔颌面部插管全麻手术需鼻饲流质的患者安置胃管的最佳时机.方法 随机选取2011年9月至2012年6月我科口腔颌面部手术后需安置胃管的患者60例作为对照组,2012年7月至2013年4月我科口腔颌面部手术后需安置胃管的患者60例作为观察组.观察组于手术结束后、麻醉拔管前在麻醉师的协助下利用可视喉镜安放胃管,对照组于术后第一天患者清醒状态下在病房安置胃管.比较两组患者安置胃管的一次性成功率,安置胃管失败例数,安置胃管前和安置胃管时心率、血压变化,拒绝安置胃管的例数,术后患者对安置胃管时机的选择.结果 观察组一次性插管成功率明显高于对照组（P＜0.01）;观察组安置胃管失败人数明显低于对照组（P＜0.01）;与基础值比较,观察组在安置胃管时血压、心率无明显变化,而对照组明显增高（P＜0.001）;对照组拒绝安置胃管的人数明显高于观察组;留管期间调查,患者要求手术结束后、麻醉拔管前安置胃管率为100％.结论 口腔颌面部插管全麻手术需鼻饲流质的患者安置胃管的最佳时机是手术结束后、麻醉拔管前.

Timing of putting stomach tube of general anesthesia patients in oral and maxillofacial region

Objective To explore the best moment of putting stomach tube when the patient with general anesthesia was performed operation in oral and maxillofacial region.Methods Sixty patients who needed to put stomach tube after operation in oral and maxillofacial department from September,2011 to June,2012 were selected as control group randomly,with 60 patients from July,2012 to April,2013 as experimental group.The patient of experimental group was put stomach tube at the time when the operation was over and before trachea,and carmula was extracted through visionlaryngoscope with the help of anesthetist and the patient of control group at the first day after operation in ward.The rate of success of putting stomach tube of the first time,number of failure,change of heart rate and blood pressure before and when putting stomach tube,number of refusing to put stomach tube and the time of the patient chosing to put stomach tube were compared between the two groups.Results The rate of success of putting stomach tube of the first time of experimental group was significantly higher than that in control group （P＜0.01）.The number of failure of experimental group was significantly lower than that in control group （P＜0.01）.Compared with the basis,the heart rate and blood pressure of experimental group had no significant change and those of control group rised obviously （P＜0.001）.The number of refusing to put stomach tube in control group was significantly higher than that in experimental group.100％ patients required stomach tube to be put at the time after operation and before trachea cannula was extracted.Conclusion The best timing of putting stomach tube in oral and maxillofacial operation under general anesthesia is the time after operation or before trachea cannula is extracted.