氧驱动雾化吸入表面麻醉对重型颅内感染患者颅内压影响研究
|
摘要
目的探讨氧驱动雾化吸入表面麻醉对重型颅内感染患者颅内压及术后并发症的影响。方法选取2015年6月至2017年5月浙江中医药大学附属第二医院收治的重型颅内感染患者30例,随机分为试验组和对照组,每组15例。对照组患者治疗期间行传统喉部喷雾表面麻醉联合环甲膜穿刺气管黏膜麻醉,试验组行氧驱动雾化吸入表面麻醉,所有患者麻醉后均在清醒下纤维光导喉镜引导插管,分析不同麻醉后插管患者颅内压及术后不良反应。结果试验组患者一次性插管成功率(93.33%)高于对照组(73.33%),差异有统计学意义(χ~2=14.398,P<0.05)。试验组患者发生颅内压增高率(66.67%)低于对照组(86.67%),差异有统计学意义(χ~2=11.181,P=0.001)。插管期间,试验组患者不良反应发生率(26.67%)低于对照组(46.67%),差异有统计学意义(χ~2=8.612,P=0.003)。结论给予重型颅内感染患者氧驱动雾化吸入表面麻醉,在清醒下纤维光导喉镜引导插管成功率高,降低插管不良反应,减轻对患者颅内压的影响。
Objective To investigate the effects of oxygen-driven aerosol inhalation topical anesthesia on intracranial pressure and postoperative complications in patients with severe intracranial infection. Methods Thirty patients with severe intracranial infection admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from June 2015 to May 2017 were randomly divided into the experimental group(n=15) and control group(n=15). Patients in control group underwent conventional laryngeal spray surface anesthesia combined with ring-shaped perforating tracheal mucosal anesthesia, while patients in the experimental group underwent oxygen-driven aerosol inhalation for surface anesthesia. All patients underwent intubation guided by fiberoptic laryngoscope under anesthesia. The effects of anesthesia on intracranial pressure and postoperative adverse reactions were evaluated. Results The first-time intubation success rate was significantly higher among patients in the experimental group than those in control group(93.33% vs 73.33%, χ~2=14.398, P<0.05). The incidence of increased intracranial pressure was significantly lower in the experimental group than that in the control group(66.67% vs 86.67%, χ~2=11.181, P=0.001). During the intubation, the incidence of postoperative adverse reaction was significantly lower in the experimental group than that in the control group(26.67% vs 46.67%, χ~2=8.612, P=0.003). Conclusions Oxygen-driven aerosol inhalation topical anesthesia in patients with severe intracranial infection is effective in guiding the intubation
Objective To investigate the effects of oxygen-driven aerosol inhalation topical anesthesia on intracranial pressure and postoperative complications in patients with severe intracranial infection. Methods Thirty patients with severe intracranial infection admitted to the Second Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from June 2015 to May 2017 were randomly divided into the experimental group(n=15) and control group(n=15). Patients in control group underwent conventional laryngeal spray surface anesthesia combined with ring-shaped perforating tracheal mucosal anesthesia, while patients in the experimental group underwent oxygen-driven aerosol inhalation for surface anesthesia. All patients underwent intubation guided by fiberoptic laryngoscope under anesthesia. The effects of anesthesia on intracranial pressure and postoperative adverse reactions were evaluated. Results The first-time intubation success rate was significantly higher among patients in the experimental group than those in control group(93.33% vs 73.33%, χ~2=14.398, P<0.05). The incidence of increased intracranial pressure was significantly lower in the experimental group than that in the control group(66.67% vs 86.67%, χ~2=11.181, P=0.001). During the intubation, the incidence of postoperative adverse reaction was significantly lower in the experimental group than that in the control group(26.67% vs 46.67%, χ~2=8.612, P=0.003). Conclusions Oxygen-driven aerosol inhalation topical anesthesia in patients with severe intracranial infection is effective in guiding the intubation
引文
[1] Kawoos U, McCarron RM, Auker CR, et al.Advances in intracranial pressure monitoring and its significance in managing traumatic brain injury[J].Int J Mol Sci, 2015, 16(12):28979-28997.
[2] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].新医学, 2005, 36(8):495.
[3] Han J, Yang S, Zhang C, et al.Impact of intracranial pressure monitoring on prognosis of patients with severe traumatic brain Injury:A PRISMA systematic review and meta-analysis[J].Medicine (Baltimore),2016, 95(7):e2827.
[4] Kawoos U, McCarron R, Auker C, et al.Advances in intracranial pressure monitoring and its significance in managing traumatic brain injury[J].Int J Mol Sci, 2015, 16(12):28979-28997.
[5] 张雁华, 魏立民, 王天龙.氧驱动雾化吸入气道表面麻醉下清醒气管插管成功一例[J].临床麻醉学杂志, 2010, 26(8):736.
[6] Bian F, Wu YE, Zhang CL.Use of aerosol inhalation treatment with budesonide and terbutaline sulfate on acute pediatric asthmatic bronchitis[J].Exp Ther Med, 2017, 14(2):1621-1625.
[7] Usmani OS, Biddiscombe MF, Yang S, et al.The topical study of inhaled drug (salbutamol) delivery in idiopathic pulmonary fibrosis[J].Respir Res, 2018, 19(1):25.
[8] 田小文, 蔡翠珠, 赵如峰, 等.万古霉素两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床研究[J].中国药房, 2017, 28(5):653-656.
[9] 张磊, 陈汉明, 张友华, 等.静脉输注联合脑室内注射美罗培南治疗神经外科术后颅内感染的临床效果研究[J].实用心脑肺血管病杂志, 2016, 24(11):107-111.
[10] 张惠芳, 阿依古丽·牙生.闪光视觉诱发电位无创检测颅内感染颅内压的临床应用[J].中国医师杂志, 2016, 18(s1):125-126.
[11] 王立江, 元小冬.有创颅内压监测技术在重型颅脑损伤患者中的应用价值[J].解放军医药杂志, 2017, 29(8):55-59.
[12] 曾海清, 李幽然, 张国军.脑脊液CRP、CHE、UA在神经外科术后颅内感染诊断价值的研究[J].检验医学与临床, 2016, 13(9):1192-1194.
[13] 惠军, 张彬, 左毅, 等.鞘内注射药物联合腰大池置管持续引流术对颅脑术后颅内感染治疗效果评价[J].临床和实验医学杂志, 2016, 15(17):1667-1670.
[2] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].新医学, 2005, 36(8):495.
[3] Han J, Yang S, Zhang C, et al.Impact of intracranial pressure monitoring on prognosis of patients with severe traumatic brain Injury:A PRISMA systematic review and meta-analysis[J].Medicine (Baltimore),2016, 95(7):e2827.
[4] Kawoos U, McCarron R, Auker C, et al.Advances in intracranial pressure monitoring and its significance in managing traumatic brain injury[J].Int J Mol Sci, 2015, 16(12):28979-28997.
[5] 张雁华, 魏立民, 王天龙.氧驱动雾化吸入气道表面麻醉下清醒气管插管成功一例[J].临床麻醉学杂志, 2010, 26(8):736.
[6] Bian F, Wu YE, Zhang CL.Use of aerosol inhalation treatment with budesonide and terbutaline sulfate on acute pediatric asthmatic bronchitis[J].Exp Ther Med, 2017, 14(2):1621-1625.
[7] Usmani OS, Biddiscombe MF, Yang S, et al.The topical study of inhaled drug (salbutamol) delivery in idiopathic pulmonary fibrosis[J].Respir Res, 2018, 19(1):25.
[8] 田小文, 蔡翠珠, 赵如峰, 等.万古霉素两种给药途径辅助持续引流治疗脑外伤继发颅内感染的临床研究[J].中国药房, 2017, 28(5):653-656.
[9] 张磊, 陈汉明, 张友华, 等.静脉输注联合脑室内注射美罗培南治疗神经外科术后颅内感染的临床效果研究[J].实用心脑肺血管病杂志, 2016, 24(11):107-111.
[10] 张惠芳, 阿依古丽·牙生.闪光视觉诱发电位无创检测颅内感染颅内压的临床应用[J].中国医师杂志, 2016, 18(s1):125-126.
[11] 王立江, 元小冬.有创颅内压监测技术在重型颅脑损伤患者中的应用价值[J].解放军医药杂志, 2017, 29(8):55-59.
[12] 曾海清, 李幽然, 张国军.脑脊液CRP、CHE、UA在神经外科术后颅内感染诊断价值的研究[J].检验医学与临床, 2016, 13(9):1192-1194.
[13] 惠军, 张彬, 左毅, 等.鞘内注射药物联合腰大池置管持续引流术对颅脑术后颅内感染治疗效果评价[J].临床和实验医学杂志, 2016, 15(17):1667-1670.