The Clinical Study on the Effects of Sedation，Analgesia and Slow Induction of Endotracheal Intubation on Hemodynamics，Reduction of Postoperative Adverse Memory and Psycho-psychological Effects in Patients with General Anesthesia
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摘要:
目的 探讨镇静镇痛慢诱导气管插管技术对减轻血流动力学波动，减少清醒气管插管对手术患者产生术后不良记忆、负面情绪、心理或精神影响。 方法 选取昆明市第二人民医院2017年6月至2020年10月所收治的全身麻醉气管插管下非仰卧位手术患者116例，采用随机数字表法分为研究组和对照组，每组各58例，对照组患者给予常规快速诱导全麻气管插管，由医护人员完成体位摆放；研究组患者给予充分镇静、镇痛、气管表面麻醉慢诱导并保留自主呼吸行气管插管，医护人员在患者自主配合下完成体位摆放后进行全身麻醉。对比2组患者血流动力学指标、术后记忆情况及心理状态评估。 结果 2组T1时间点组间收缩压（SBP）、舒张压（DBP）、心率（HR）血流动力学稳定未见统计学差异（P > 0.05）；T 2时间点组间收缩压（SBP）、舒张压（DBP）、心率（HR）血流动力学稳定研究组优于对照组（P < 0.05）。2组T 3时间点收缩压（SBP）、舒张压（DBP）、心率（HR）组间比较血流动力学稳定对照组优于研究组（P < 0.05），2组T 4时间点收缩压（SBP）、舒张压（DBP）、心率（HR）组间比较血流动力学稳定研究组优于对照组（P < 0.05）。研究组给药开始至完成气管插管时间长于对照组（ P < 0.05），2组手术结束至清醒拔除气管导管时间无明显统计学差异（ P > 0.05）。2组患者术后1 d对进入手术室后记忆、心理状态测评组间及组内比较均未见明显统计学差异（ P > 0.05）。 结论 全麻手术患者采用镇静、镇痛慢诱导气管插管技术不会增加患者产生术后不良记忆、负面情绪、心理或精神影响的概率。慢诱导临床操作时间稍长于快诱导，但不会引起苏醒延迟及拔管延迟，虽然插管时造成一定程度的血流动力学变化，但影响轻微，拔管时可减少拔管刺激引起的不良反应，对血流动力学影响优于快诱导气管插管。 Abstract:Objective To investigate the effects of sedation and analgesia induced tracheal intubation on reducing hemodynamic fluctuation and conscious tracheal intubation on postoperative adverse memory, negative emotion, psychological or mental effects. Methods 116 patients who were treated in our hospital from June 2017 to October 2020 were divided into the study group and the control group, with 58 cases in each group. The control group was given routine rapid induction of general anesthesia rapid induction of general anesthesia tracheal intubation, the medical staff completed posture placement, the study group was given sedation, analgesia, tracheal surface anesthesia slowly induced to lethargy and retained spontaneous breathing tracheal intubation. The hemodynamic indexes, postoperative memory and psychological status of the two groups were compared. Results There was no significant difference in the hemodynamic stability between the two groups T1 time points （P > 0.05）; the systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） hemodynamic stability of the study group was better than those of the control group （ P < 0.05）. Of the two groups, the T3 time point systolic blood pressure （SBP）, diastolic blood pressure （DBP）, heart rate （HR） of the study group were better than those of the control group （0.05）, the systolic blood pressure （SBP）, diastolic blood pressure （DBP）, and heart rate （HR） of the study group were better than those of the control group （ P < 0.05）. From the beginning of administration to the completion of tracheal intubation in the study group （ P < 0.05）, At the end of operation, there was no significant difference between the two groups （ P > 0.05）. There was no significant difference in memory and mental state between the two groups 1 d after operation （ P > 0.05）. Conclusion Sedation, analgesia and slow induction of tracheal intubation in patients undergoing general anesthesia will not increase the probability of postoperative adverse memory, negative emotional, psychological or mental effects. The clinical operation time of slow induction is slightly longer than that of fast induction, but it will not cause the delay of awakening and extubation. Although the hemodynamic changes are caused by intubation, the effect is slight. Extubation can reduce the adverse reactions caused by extubation stimulation, and the hemodynamic effect is better than that of fast induced tracheal intubation. -
Key words:
- Sedation /
- Analgesia /
- Slow induction /
- Tracheal intubation /
- General anesthesia /
- Hemodynamics /
- Mental state /
- Bad memory
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图 1 2组临床用时指标对比（n = 58）
Figure 1. Comparison of clinical time record indexes between two groups（n = 58）
表 1 2组血流动力学指标对比（ $\bar x \pm s$）
Table 1. Comparison of hemodynamic indexes between the two groups （ $\bar x \pm s$）
指标 组别 时间点 F，P T1 T2 T3 T4 SBP
（mmHg）对照组 138.19 ± 7.32 101.72 ± 6.51 103.38 ± 7.84 139.21 ± 5.75 531.30， < 0.001 研究组 138.64 ± 7.81 127.41 ± 6.33 137.73 ± 8.62 126.51 ± 6.17 45.950， < 0.001 t/P 0.320/0.749 21.547/ < 0.001 22.451/ < 0.001 11.468/ < 0.001 DBP
（mmHg）对照组 60.19 ± 6.36 49.43 ± 5.82 50.25 ± 7.13 67.57 ± 6.48 103.955， < 0.001 研究组 60.43 ± 6.10 55.13 ± 5.65 62.31 ± 7.53 60.33 ± 5.14 14.495， < 0.001 t/P 0.207/0.836 5.352/ < 0.001 8.857/ < 0.001 6.666/ < 0.001 HR
（次/min）对照组 81.35 ± 6.73 91.54 ± 6.25 95.58 ± 6.33 103.29 ± 7.46 107.525， < 0.001 研究组 80.58 ± 6.17 77.63 ± 6.82 102.18 ± 7.97 90.20 ± 6.75 146.952， < 0.001 t/P 0.642，0.522 11.452， < 0.001 4.939， < 0.001 9.909， < 0.001 注：收缩压（SBP）：F组别 = 15.672，P组别 < 0.001； F时间 = 465.584，P时间 < 0.001； F组别*时间 = 7.256，P组别*时间 < 0.001；舒张压（DBP）： F组别 = 7.956，P组别 = 0.006；F时间 = 84.157，P时间 < 0.001； F组别*时间 = 3.586，P组别*时间 = 0.014；心率（HR）：F组别 = 10.268，P组别 = 0.002；F时间 = 132.594，P时间 < 0.001； F组别*时间 = 9.536，P组别*时间 < 0.001。 
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表 2 2组临床用时指标对比[（ $\bar x \pm s$），min]
Table 2. Comparison of clinical time record indexes between two groups [（ $\bar x \pm s$），min]
组别 插管时间 拔管时间 对照组（n = 58） 9.75 ± 2.14 11.58 ± 2.52 研究组（n = 58） 14.32 ± 3.63 11.08 ± 2.14 t 8.259 1.152 P < 0.001 * 0.252 *P < 0.05。
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表 3 2组麻醉过程中记忆得分对比[（ $\bar x \pm s$），分]
Table 3. Memory of anaesthesia treatment score between the two groups [（ $\bar x \pm s$），scores]
组别 插管中记忆评分 操作时间位点评分 韦氏量表评分 总分 对照组（n = 58） 0.00 1.94 ± 0.02 2.13 ± 0.07 4.08 ± 0.15 研究组（n = 58） 0.00 1.95 ± 0.05 2.15 ± 0.08 4.11 ± 0.18 t - 1.414 1.433 0.975 P - 0.160 0.155 0.332
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表 4 2组焦虑评分对比[（ $\bar x \pm s$），分]
Table 4. Comparison of anxiety between the two groups [（ $\bar x \pm s$），scores]
组别 手术前HAMA评分 手术后1 d HAMA评分 t P 对照组（n = 58） 15.21 ± 2.14 9.63 ± 2.12 14.107 < 0.001 * 研究组（n = 58） 15.35 ± 3.63 9.58 ± 2.66 9.765 < 0.001 * t 0.253 0.112 P 0.801 0.911 *P < 0.05。
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表 5 2组焦虑评分对比[（ $\bar x \pm s$），分]
Table 5. Comparison of depression between the two groups [（ $\bar x \pm s$），scores]
组别 手术前HAMD评分 手术后1 d HAMD评分 t P 对照组（n = 58） 5.41 ± 3.37 5.32 ± 2.74 0.158 0.875 研究组（n = 58） 5.87 ± 3.49 5.57 ± 2.29 0.547 0.585 t 0.722 0.533 P 0.472 0.595
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