无肌松药维持下全麻经口双气囊小肠镜检查的随机对照研究
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1.南京大学医学院附属南京鼓楼医院;2.南京大学医学院附属南京鼓楼医院麻醉科

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Effects of general anesthesia maintenance without muscle relaxants for double-balloon enteroscopy: a randomized controlled trial
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Nanjing University Medical School Affiliated Nanjing Drum Tower Hospital

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    摘要:

    目的评估无肌松药维持下全麻经口双气囊小肠镜(DBE)检查的效果和安全性。方法拟行经口DBE检查的120例气管插管全麻患者,按照随机数字表法随机分为2组,观察组无肌松剂维持,对照组按时追加肌松剂。监测患者麻醉诱导前(T0)、插管后即刻(T1)、置内镜时(T2)、退镜完毕(T3)、苏醒时(T4)的平均动脉压(MAP)、心率(HR)、气道压(Ppeak)、呼气末二氧化碳分压(PETCO2),记录检查结束前自主呼吸恢复例数,检查结束后苏醒时间、拔管时间、PACU停留时间,不良反应发生情况及操作者对麻醉效果的满意率。结果经剔除标准剔除12例,剩余108例完成研究,其中观察组56例、对照组52例,2组全麻诱导气管插管的一次成功率均为100%。MAP、HR、Ppeak、PETCO2,各观察时间点2组间比较差异均无统计学意义(P均>005),且组内与T0比较差异亦均无统计学意义(P均>005)。观察组的自主呼吸恢复率明显高于对照组[100%(56/56)比42%(22/52),χ2=4473,P<0001]。呼之睁眼时间、拔管时间以及PACU停留时间观察组分别为(6±2)min、(10±3)min、(11±4)min,对照组分别为(15±5)min(t=-1264,P<0001)、(17±5)min(t=-890,P<0001)、(17±7)min(t=-573,P<0001),2组间差异均有统计学意义。拔管后,2组均未出现需要持续加压辅助通气的病例,对照组出现低氧血症2例、恶心3例,观察组出现恶心1例,2组总体不良反应发生率比较差异无统计学意义(P>005)。2组内镜操作者对麻醉效果的满意率均为100%。结论无肌松药维持下全麻经口DBE检查安全、可行,具有患者自主呼吸恢复快、清醒快、拔管早、费用少等优势。

    Abstract:

    ObjectiveTo evaluate the feasibility and safety of maintaining general anesthesia without neuromuscular blockade in oral double-balloon enteroscopy. MethodsTotally 120 patients undergoing oral double-balloon enteroscopy under general anesthesia were randomly assigned into two groups: the observation group and the control group. The observation group was not given muscle relaxants for anesthesia maintenance, while the control group was given muscle relaxants punctually. Observation indexes were monitored, including the mean arterial pressure (MAP), heart rate (HR), peak airway pressure (Ppeak) and end-tidal CO2 partial pressure (PETCO2) before anesthesia (T0), immediately after intubation (T1), at the time of endoscopy placement (T2), at the end of endoscopy withdrawal (T3), and at the time of waking-up (T4). The cases of spontaneous breathing recovery before the end of endoscopy, postoperative recovery time, extubation time, length of PACU stay, postoperative adverse reactions and satisfactory rates were recorded. ResultsTwelve cases were removed by the exclusion criteria, and the remaining 108 cases completed the study, including 56 cases in the observation group and 52 cases in the control group. The one-time success rate of induction was both 100% in the two groups. There were no significant differences in MAP, HR, Ppeak, and PETCO2 between the two groups at each observation point (all P>005), and the same is true for within group comparison with T0 (all P>005). The recovery rate of spontaneous respiration in the observation group was significantly higher than that in the control group [100% (56/56) VS 42% (22/52), χ2=44.73, P=0000]. The awaken time, extubation time and length of PACU stay were 6±2 min, 10±3 min, and 11±4 min, respectively, in the observation group, compared with 15±5 min (t=-1264, P=0000), 17±5 min (t=-890, P=0000), and 17±7 min (t=-573, P=0000) in the control group. None of the patients required assisted ventilation. Hypoxemia occurred in 2 cases and nausea in 3 cases in the control group, while only nausea occurred in 1 patient in the observation group. The overall incidence of adverse reactions was not statisticaly different between the two groups (P>005). Anesthesia satisfaction rate of two groups was 100%. ConclusionIt is feasible and safe to perform oral double-balloon enteroscopy without muscle relaxants during maintaining under general anesthesia, with quick recovery of spontaneous breathing and awakening, early extubation and less cost.

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夏小萍,王尔华,汪小海.无肌松药维持下全麻经口双气囊小肠镜检查的随机对照研究[J].中华消化内镜杂志,2019,36(10):750-754.

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  • 收稿日期:2019-06-01
  • 最后修改日期:2019-09-15
  • 录用日期:2019-07-08
  • 在线发布日期: 2019-10-28
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