全麻术后患者不吸痰拔除导管的心血管应激反应观察

目的探讨不吸痰对全麻患者拔除气管导管的安全性。方法108例静吸复合全麻患者，手术结束后送入麻醉恢复室。依患者情况给予常规吸痰护理，待清醒时拔除气管导管，随机分成两组，A组清醒时吸痰后拔除导管（n=50例），B组清醒时不再吸痰直接拔管（n=58例）。以患者呼之睁眼，应答正确，配合动作，握拳有力，脱氧10min血氧饱和度维持在95％以上为拔管指标，观察拔管前、拔管即刻、拔管后3和10rain时的心血管反应，确定不吸痰的安全可行性。结果A组、B组拔管即刻、拔管后3min的血压、心率与拔管前相比均升高；A组患者血氧饱和度在拔管即刻、拔管后3min时较拔管前有所降低，两组相比，差异有统计学意义。结论在不吸痰的情况下，清醒后直接拔除气管导管，避免了患者拔管后的缺氧，减少了患者的心血管应激反应。

Observation on cardiovascular stress response of catheter removal without sputum aspiration in patients undergoing general anesthesia operation

Objective] To explore the safety of catheter removal without sputum aspiration in patients undergoing general anesthesia operation. Methods] 108 patients undergoing intravenous-inhalation combined anesthesia were collected after operation. The pa- tients were given the conventional sputum suction nursing, and received the catheter removal when they were awakened. The pa- tients were randomly divided into two groups ： group A received the catheter removal after sputum aspiration （ 50 cases }, and group B received the catheter removal without sputum aspiration （ 58 cases ）. The extubation indicator was patient can open eyes when hearing his/her name, answer correctly, cooperate the movement, clench hands powerfully, and the oxyhemoglobin saturation maintains over 95% after removing inspired oxygen for 10 min. The cardiovascular stress responses before catheter removal, at the moment of catheter removal, 3 and 10 min after catheter removal were observed, to determine the feasibility of catheter removal without sputum aspiration. Results ] In group A and group B, the blood pressure and heart rate at the moment of catheter removal and 3 min after catheter removal increased as compared with those before catheter removal. The oxyhemoglobin saturation at the mo- ment of catheter removal and 3 min after catheter removal in group A was lower than that before catheter removal. The differences were significant. Conclusion ] Without sputum aspiration, carrying out catheter removal directly when patients are awakened can a- void hypoxia after catheter removal, and reduce the cardiovascular stress responses.