腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响
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1.南京医科大学盐城临床医学院, 盐城市第三人民医院;2.南京医科大学第一附属医院

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江苏省自然科学基金


Effect of tracheal tube cuff pressure control on intraoperative hemodynamics and postoperative sore throat during laparoscopic colorectal surgeryLIU Chao1, Ji Lin1, LIU Cun-ming2*
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Natural Science Foundation of Jiangsu Province

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    摘要:

    目的: 探讨腹腔镜结直肠手术中气管导管套囊压力控制对术中血流动力学及术后咽喉痛的影响。方法: 选择行腹腔镜结、直肠癌根治手术的患者94例。采用随机数字表将患者随机分为A组(导管套囊压力控制组, n = 48)和B组(指感法组, n = 46)。A组患者套囊压力控制在25~30 cmH2O,B组患者仅监测套囊压力。所有患者监测并记录麻醉诱导前(T0),气管插管后(T1),建立气腹前(T2),建立气腹后(T3),头低足高位后(T4),气管拔管前(T5),气管拔管后(T6)时间点的HR、MAP,以及T1、T2、T3、T4、T5时间点的套囊压力和气道压力。同时调查患者术后2 h、12 h及术后24 h的咽痛、声嘶情况。结果: B组的套囊压力在T1、T2、T3、T4、T5均明显高于A组(P < 0.05)。两组病人T3时间点的气道压力均明显上升(P < 0.05),T4时间点均进一步升高(P < 0.05),但两组之间没有显著性差异。B组病人的HR、MAP在T1、T2、T3、T4、T5时间点均高于A组(P < 0.05)。A组术后2 h、12 h咽痛发生率低于B组(P < 0.05)。两组患者术后2 h、12 h、24 h声嘶发生率及严重程度相比无统计学差异(P > 0.05)。结论: 腹腔镜手术中,控制气管导管套囊压力可以降低术后咽痛的发生率,并能保持术中血流动力学的相对稳定。

    Abstract:

    Objective: To investigate the effect of tracheal tube cuff pressure control on intraoperative hemodynamics and postoperative sore throat during laparoscopic colorectal surgery. Methods: Ninety-four patients who underwent laparoscopic radical surgery for colorectal and rectal cancer were selected were randomly divided into Group A (tracheal tube cuff pressure control group, n = 48) and Group B (finger sensation method group, n = 46). The pressure of the tracheal tube cuff in Group A was controlled at 25-30 cmH2O, while the pressure in Group B only be monitored. HR and MAP were continuously monitored and recorded at seven time points including before induction of anesthesia (T0), after intubation (T1), before establishment of pneumoperitoneum (T2), after establishment of pneumoperitoneum (T3), after Trendelenburg position (T4), before tracheal extubation (T5), after tracheal extubation (T6). Tracheal tube cuff pressure and airway pressures at the time points of T1, T2, T3, T4 and T5 were measured and recorded. The incidence and severity of sore throat and hoarseness were investigated in patients at 2 h, 12 h and 24 h after surgery. Results: The cuff pressure in Group B was significantly higher than that in Group A at T1, T2, T3, T4, and T5 (P < 0.05). The airway pressure in both groups significantly increased at T3 and further increased at T4 (P < 0.05), but there was no significant difference between the two groups. Compared with those in group A, HR and MAP were higher in group B at T1, T2, T3, T4 and T5 time points (P < 0.05). The incidence of postoperative sore throat at 2 h and 12 h was lower in group A than that in group B (P < 0.05). There was no statistical difference in the incidence and severity of postoperative hoarseness at 2 h, 12 h and 24 h in the two groups (P > 0.05). Conclusion: In patients undergoing laparoscopic colorectal surgery, tracheal tube cuff pressure control can reduce the incidence of postoperative sore throat and maintain the relative stability of intraoperative hemodynamics.

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  • 收稿日期:2024-02-07
  • 最后修改日期:2024-03-31
  • 录用日期:2024-07-04
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