气管内插管全麻在支气管肿瘤冷冻术中的麻醉效果及安全性

目的观察气管内插管全麻在支气管肿瘤冷冻术中的麻醉效果并评价其安全性。方法选择2012年6月至2013年9月收治的78例支气管肿瘤患者,随机分为气管内插管全麻组(观察组)和静脉镇静加气管内表面麻醉组(对照组),观察两组患者不同时间段平均动脉压(MAP)、心率(HR)以及氧分压(SO2)水平的变化,并评价各种方法的安全性。手术后3个月和6个月时进行随访,并采用健康测量量表(SF-36)进行生活质量评定。结果两组患者的MAP、HR水平在麻醉前(T0)比较,差异无统计学意义(P>0.05);观察组患者的MAP和HR水平在冷冻开始前(T1)、冷冻开始后30 min(T2)、冷冻结束时(T3)均低于对照组,差异有统计学意义(P<0.05);两组患者的SO2水平在各时间节点比较,差异均无统计学意义(均P>0.05)。两组患者术后的血常规及肝肾功能检测均未见异常。观察组患者无不良反应,对照组患者发生不良反应20例(51.3%),差异有统计学意义(P<0.01)。在术后3个月和6个月时,观察组患者的生活质量指标生理机能(PF)、生理职能(RP)和情感职能(RE)评分均高于对照组,差异有统计学意义(P<0.01)。结论支气管肿瘤冷冻术中应用气管内插管全麻麻醉效果更佳,且安全性高,有利于提高患者术后生活质量。

Study on the anesthesia effect and safety of tracheal intubation anesthesia in bronchial tumor cryo- surgery

Objective To observe the anesthesia effect and evaluate the safety of tracheal intuba- tion anesthesia in bronchial tumor cryosurgery. Methods Selected 78 cases of bronchial tumor patients who were treated in The Second Hospital of Chaoyang District. Then randomly divided them into tracheal intuba- tion anesthesia group （observation group） and intravenous sedation combined with tracheal surface anesthe- sia group （control group）. Observed the changes of MAP, HR and PaO2 levels of different time, and as- sessed the safety of different methods. Followed up at 3 months and 6 months after surgery, and adopted SF- 36 to assess the quality of life of the patients. Results The MAP and HR levels of the two groups had no statistical difference at TO （P 〉 0. 05 ）, but had statistical difference at T1 ,T2 and T3 （P 〈 0. 05 ）. As for PaO2 levels of the two groups, the differences were not statistically significant at TO,T1 ,T2 and T3 （P 〉 0. 05）. The postoperative blood routine examination and liver and renal function tests of all the patients of the two groups were normal. Untoward effect didnt occur in observation group, while 20 cases occurred in control group （51.3%）, and the differences were statistically significant （P 〈0.01 ）. Every case was fol- lowed up in each group. The quality of life index PF,RP and RE scores of patients in observation group were higher than that of control group at 3 and 6 months, which was statistically different （ P 〈 O. 01）.Conclusion Applying tracheal intubation anesthesia in bronchial tumor cryosurgery can be more effective and safe, and is helpful to improve patients＂ quality of life after surgery.