经尿道膀胱肿瘤切除术患者麻醉后出现高呼吸阻力的相关因素
Factors Causing Post-Anesthetic High Respiratory Resistance in Patients Undergoing Transurethral Resection of Bladder Tumors.
作者信息
Nakahira Junko, Nakano Shoko, Sawai Toshiyuki, Ishio Junichi, Ono Naomi, Minami Toshiaki
机构信息
Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan.
出版信息
Anesth Pain Med. 2017 Jan 31;7(2):e44553. doi: 10.5812/aapm.44553. eCollection 2017 Apr.
BACKGROUND
In this study, we investigated the causes of high respiratory resistance that is observed after general anesthesia. We focused on respiratory resistance at 5 Hz (R5), which were measured preoperatively and postoperatively.
METHODS
Our prospective observational study enrolled 68 patients who underwent transurethral resection of bladder tumors from April to October 2015. Respiratory impedance was measured the day before surgery and immediately after general anesthesia. Participants were divided into 2 groups: Group L (postoperative R5 values < 4.0 cmHO/L/sec; n = 33) and Group H (postoperative R5 values ≥ 4.0 cmHO/L/sec; n = 35). Patient background, preoperative R5 values, endotracheal tube or subglottic devices, anaesthetic period, desflurane or sevoflurane, and endotracheal suctioning were compared.
RESULTS
Significant parameters were height, inhalation of desflurane, endotracheal suctioning, and preoperative R5 value. Logistic regression showed that endotracheal suctioning and a higher preoperative R5 level increased postoperative respiratory resistance (> 4 cmHO/L/sec).
CONCLUSIONS
The endotracheal suctioning at the end of anesthesia influenced respiratory resistance more than use of the endotracheal tube and desflurane.
背景
在本研究中，我们调查了全身麻醉后出现高呼吸阻力的原因。我们重点关注术前和术后测量的5Hz时的呼吸阻力（R5）。
方法
我们的前瞻性观察性研究纳入了2015年4月至10月期间接受经尿道膀胱肿瘤切除术的68例患者。在手术前一天和全身麻醉后立即测量呼吸阻抗。参与者分为两组：L组（术后R5值<4.0cmH₂O/L/秒；n = 33）和H组（术后R5值≥4.0cmH₂O/L/秒；n = 35）。比较患者背景、术前R5值、气管内导管或声门下装置、麻醉时间、地氟烷或七氟烷以及气管内吸引情况。
结果
显著参数为身高、地氟烷吸入、气管内吸引和术前R5值。逻辑回归显示，气管内吸引和较高的术前R5水平会增加术后呼吸阻力（>4cmH₂O/L/秒）。
结论
麻醉结束时的气管内吸引对呼吸阻力的影响大于气管内导管和地氟烷的使用。
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