中国口腔颌面外科杂志

中国口腔颌面外科杂志 ›› 2024, Vol. 22 ›› Issue (2): 181-185.doi: 10.19438/j.cjoms.2024.02.012

• 论著 • 上一篇    下一篇

不同体位对正颌术后气管拔管安全性及应激反应的影响

王烨, 黄慧敏, 王圆*, 吕翔*   

  1. 上海交通大学医学院附属第九人民医院 麻醉科,上海 200011
  • 收稿日期:2023-10-08 修回日期:2023-11-21 出版日期:2024-02-20 发布日期:2024-03-27
  • 通讯作者: 王圆,E-mail: wangyuanmzk@163.com;吕翔,E-mail: mzklvxiang@163.com。*共同通信作者
  • 作者简介:王烨（1984-),女,硕士,E-mail: wangye31035023@163.com

Comparison of stress response and safety of nasotracheal extubation following orthognathic surgery under different body position

WANG Ye, HUANG Hui-min, WANG Yuan*, LYU Xiang*   

  1. Department of Anesthesiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine. Shanghai 200011, China
  • Received:2023-10-08 Revised:2023-11-21 Online:2024-02-20 Published:2024-03-27

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摘要： 目的: 探讨正颌术后患者轻度镇静下不同体位拔除气管导管的应激反应和安全性差异,为正颌术后拔管体位的选择提供参考。方法: 回顾2022年1月—2022年12月全麻下行正颌手术患者230例,根据拔管体位分为平卧位组(n=115)和侧卧位组(n=115)。比较2组患者拔管前5 min (镇静状态下,T0)、拔管前1 min (平卧位/侧卧位,T1)、拔管后1 min (T2)、拔管后5 min (T3)的收缩压(SBP)、舒张压(DBP)和心率(HR),作为评价拔管应激反应指标;比较2组患者拔管后鼻出血、口腔渗血、声嘶、咽痛、哮鸣音、喉痉挛、咳嗽、躁动以及舌后坠等不良反应发生率,作为评价拔管安全性指标。采用SPSS 26.0软件包对数据进行统计学分析。结果: 不同时间点两组间比较,T1时侧卧位组的SBP、DBP及HR显著高于平卧位组（P<0.05）;T2及T3时侧卧位组SBP、DBP及HR显著低于平卧位组（P<0.05）。侧卧位组舌后坠发生率为0.87% (1/115),显著低于平卧位组的6.96%（8/115,P<0.05）。侧卧位组咳嗽发生率为3.48% (4/115),显著低于平卧位组10.43%（12/115,P<0.05）。两组患者鼻出血、口腔渗血、声嘶、哮鸣音、喉痉挛、躁动等不良反应发生率无统计学差异（P>0.05）。结论: 轻度镇静下,侧卧位拔管能减轻正颌术后患者拔管应激反应并减少舌后坠及咳嗽发生率,提高拔管安全性。

关键词: 正颌手术, 气管拔管, 体位, 应激反应, 安全性

Abstract: PURPOSE: To explore the differences in stress response and safety of nasotracheal extubation in different positions under light sedation after orthognathic surgery and to provide a reference for the selection of extubation position after orthognathic surgery. METHODS: According to the extubation position, patients under general anesthesia from Jan.2022 to Dec. 2022 were divided into supine position group(n=115) and lateral position group (n=115) following the orthognathic surgery. The stress response indexes including SBP, DBP and HR of the two groups were monitored and compared at 5 min before extubation (T0), 1 min before extubation(T1), 1 min after extubation (T2), and 5 min after extubation (T3). The incidence of oral bleeding, hoarseness, sore throat, laryngeal spasm, cough, agitation and retroglossal falling were compared between the two groups as the safety indexes of extubation. SPSS 26.0 software package was used for data analysis. RESULTS: Different time points, SBP, DBP and HR were significantly higher in the lateral group than that in the supine group at T1(P<0.05). SBP, DBP and HR were significantly lower in the lateral group than that in the supine group at T2 and T3(P<0.05). The incidence of retroglossal falling and cough in the lateral group were significantly lower than that in the supine group(P<0.05). There was no significant difference in the incidence of nasal bleeding, oral bleeding, hoarseness, wheezing, laryngospasm and agitation, between the two groups(P>0.05). CONCLUSIONS: It is more conductive to reduce stress response and improve the extubation safety under light sedation in lateral position than in supine position after orthognathic surgery.

Key words: Orthognathic surgery, Tracheal extubation, Body position, Stress response, Safety

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