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頁籤選單縮合
題 名 | Immediate Extubation in the Operating Room after Cardiac Operations with Thoracotomy and Sternotomy=胸廓切開及胸骨切開之開心手術後於手術室立即拔管 |
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作 者 | 林子玉; 邱冠明; 陸正威; 簡維宏; 王明鉅; 朱樹勳; | 書刊名 | 麻醉學雜誌 |
卷 期 | 45:1 2007.03[民96.03] |
頁 次 | 頁3-8 |
分類號 | 416.5 |
關鍵詞 | 麻醉恢復期; 拔管; 術後疼痛; 心臟手術; 病患自控式止痛; Anesthesia recovery period; Extubation; Pain, postoperative; Cardiac surgical procedures; Analgesia, patient-controlled; |
語 文 | 英文(English) |
中文摘要 | 背景:在台灣,開心手術後於手術室立即拔管為較罕見的作法。由於微創手術與無體外循環輔助之冠狀動脈繞道手術日漸盛行,加上來自健康保險的經濟壓力,立即拔管的應用引起我們的興趣。本研究的目的在比較微創胸廓切開與正中胸骨切開的心臟手術後,於手術室立即拔管的實行。方法:本次的研究對象為70個連續未經選取預計要接受微創胸廓切開或胸骨切開之開心手術病人。麻醉處置包括bispectral index(BIS)及train-of-four(TOF)來決定在傷口縫皮後15分鐘內的拔管。拔管的先決條件為意識清醒、肌力足夠、與不需用高量的強心劑來維持穩定的血行動力。使用病患自控式止痛來解決術後傷口疼痛的問題。結果:所有微創胸廓開胸的病人在手術結束後15分鐘內皆可立即拔管,而正胸切開的病人中有五個無法立即拔管。在正胸切開的病人拔管三十分鐘後的血中二氧化碳濃度較高,加護病房停留時間較長,且兩者皆有統計顯著意義。兩者術後疼痛及止痛藥用量無統計上顯著差異。僅有一位正胸切開的病人拔管後重新插管。在兩組病人中,並沒有手術後死亡的案例。結論:立即拔管在微創胸廓開胸或是傳統正胸切開的開心手術後是安全且可行的。如果可能的話,微創胸廓開胸因傷口小、拔管安全及病患停留時間短,為較佳的選擇。 |
英文摘要 | Background: Immediate extubation after cardiac operations in the operating room (OR) is rarely practised in Taiwan. The increased use of the minimally invasive and off-pump coronary artery bypass surgery (CABG) and the financial pressure fromhealth insurance have raised the interest of its application after cardiac operations. The purpose of the study was to investigate the practice of immediate extubation in patients undergoing cardiac operations via minimal invasive thoracotomy against via midline sternotomy. Methods: Seventy unselected consecutive patients undergoing cardiac operations via either minimally invasive thoracotomy or midline sternotomy were enrolled for investigation. Anesthetic management, including bispectral index and continuous train-of-four (TOF) monitoring, was modified to extubate the patients in the OR within 15 min after the closure of the skin wound. Extubation criteria based on clear consciousness, recovery of muscle power, and stable hemodynamics without purposeful strong inotropic support were stipulated. Patient-controlled analgesia was used to provide adequate postoperative pain control. Results: Extubation within 15 min after the end of surgery was successful in all patients who underwent thoracotomy while there were five patients who could not be extubated in the sternotomy group. The PaCO2 values 30 min after extubation and the ICU stay were significantly higher and longer in patients of the sternotomy group. The pain intensity after extubation or the doses of analgesics used did not differ between two groups of patients. There was only one patient in the sternotomy group who needed reintubation and there was no postoperative death in both groups of patients. Conclusions: We consider that immediate extubation after cardiac procedures either through thoracotomy or sternotomy is a rather safe practice and if possible minimally invasive technique should be chosen because it causes smaller wound and offers safer immediate extubation and shorter ICU stay. |
本系統中英文摘要資訊取自各篇刊載內容。