超声评估全麻手术患者气管拔管时右侧膈肌厚度变化率

摘要

Objective To evaluate the ultrasonographic value of right diaphragm thickness in patients taking general anesthesia and having signs for tracheal extubation.Methods Eighty-nine patients undergoing non-thoracic and abdominal surgery under general anesthesia were randomly assigned into a male group (46cases) and a female group (43 cases).The anesthetic was adjusted according to the vital signs during operation.The muscle relaxants was stopped and 0.8 μg/kg dexmedetomidine was administrated 30 min before the end of the surgery.5-10 MHz ultrasound probe was used to placeover 8-10 intercostal space between the anterior axillary line and the axillary line.The right diaphragmatic thickness at the end of inspiration and expiration through M-type mode during extubation and 30 min after extubation were measured,then the diaphragmatic thickness fraction(DTF) was calculated.The time from stopping muscle relaxants to extubation and Ramsay sedation score when extubation were also recorded.Results Compared with those before operation [male (59.63±10.38)％,female (57.72±9.59)％],there were statistical differences in the DTF when extuation [male (38.28±6.37)％,female (40.51±7.81)％] (P ＜ 0.05) but no in the DTF 30 min after extubation [male (58.37±9.64)％,female (56.09±8.73)％](P ＞ 0.05) in the two groups.Compared with those when extubation,there were statistical differences in the DTF 30 min after extubation in both groups (P ＜ 0.05).There were no statistical differences in the extubation time and Ramsay sedation score between the two groups (P ＞ 0.05).Conclusions It is feasible to evaluate the change of right diaphragm thickness by ultrasound in the recovery period of general anesthesia,which may be of clinical significance in judging tracheal extubation.%目的 探讨全身麻醉手术患者达到气管拔管指征时右侧膈肌厚度变化率的超声评价.方法 选择择期行非胸腹部全身麻醉手术患者89例,随机分为男性组(46例)和女性组(43例),术中根据生命体征变化调整麻醉用药,维持足够的麻醉深度,术毕前30 min停用肌松药并给予0.8μg/kg右美托咪定.术毕患者进入麻醉恢复室,采用5 ～ 10 MHz超声探头在腋前线和腋中线之间,通过第8～ 10肋间,使用M型超声记录拔管时、拔管后30 min膈肌厚度变化指标,包括吸气末膈肌厚度DTei (diaphragmatic thickness at the end of inspiration)和呼气末膈肌厚度DTee (diaphragmatic thickness at the end of expiration),并计算膈肌厚度变化率DTF (diaphragmatic thickness fraction).同时记录拔管时间和拔管时Ramsay镇静评分.结果 与术前[男(59.63±10.38)％,女(57.72±9.59)％]比较,两组拔管时DTF[男(38.28±6.37)％,女(40.51±7.81)％]差异均有统计学意义(均P＜0.05),拔管后30 min[男(58.37±9.64)％,女(56.09±8.73)％]两组DTF差异均无统计学意义(均P＞0.05);与拔管时比较,拔管后30 min两组DTF差异均有统计学意义(均P＜0.05).两组拔管时间和Ramsay镇静评分比较,差异无统计学意义(均P＞ 0.05).结论 在全身麻醉恢复期应用超声评估右侧膈肌厚度变化率具有可行性,对于判断气管拔管时机有一定的临床应用价值.