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全麻诱导期正压通气对Ⅰ度肥胖患者氧储备的影响
Effect of positive pressure ventilation during induction of general anesthesia on oxygen reserves in Ⅰ degrees obese patients
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DOI:
作者:
邵大清,祝胜美,叶志坚,卢照德,方韬
SHAO Daqing,ZHU Shengmei,YE Zhijian,LU zhaode,FANG tao
作者单位:
浙江大学医学院附属第一医院麻醉科(邵大清,祝胜美) 金华市人民医院麻醉科(叶志坚,卢照德,方韬)
Department of anesthesiology,First Affiliated Hospital,College of Medicine,Zhejiang University, Department of anesthesiology,Jinhua people's hospital.
关键词:
正压通气;肥胖;肺内分流;氧储备
Positive-pressure,ventilation; Obese; Intrapulmonary shunt; Oxygen reserves
摘要:
【摘要】 目的 观察Ⅰ度肥胖患者全麻诱导期应用持续气道正压(CPAP)/呼气末正压(PEEP)通气模式对氧储备的影响。方法 选择拟在气管插管全身麻醉下行择期腹部手术的Ⅰ度肥胖患者45例,采用随机数字表法将其分为3组(n=15):A组诱导前在自主呼吸下面罩吸纯氧5min,诱导后行面罩下普通机械通气3分钟。B 组通过面罩行CPAP吸氧5min,诱导后行面罩机械通气加用PEEP(6cmH2O)3分钟。C组的操作步骤和通气参数与A组相同,仅吸入氧气浓度调整为60%。插管后暂不连接通气环路,待SpO2降至93%时迅速连接环路通气供氧。记录插管后SpO2降至97%、95%、93%的时间。记录入室后(T1)、气管插管后(T2)2个时间点血气值,计算T2时间点肺内分流率(Qs/Qt)及氧合指数(PaO2/FiO2),记录胃胀气评分。结果 SpO2降至93%的时间:与A组相比,B组时间显著延长[A组(487.9±64.7)秒,B组(588.1 ± 93.2)秒,P<0.05],而C组时间最短(P<0.05)。SpO297%与93%差值组间比较差异无统计学意义(P>0.05)。Qs/Qt:与A组比较,B、C两组在T2时间点显著下降(P<0.05)。PaO2/FiO2:C组最高,其次为B组和A组,组间比较有显著性差异(P<0.05)。B组胃胀气评分明显增加,组间比较差异有统计学意义(P<0.05)。结论 应用正压通气模式可显著降低肺内分流率,提高氧储备,但应警惕胃胀气的风险。
【Abstract】Objective To observe the effect of continuous positive airway pressure(CPAP) and positive end-expiratory pressure(PEEP) ventilation during induction of general anesthesia on oxygen reserves in Ⅰ degrees obese patients. Methods Forty-five obese patients undergoing general anesthesia were enrolled in this prospective randomized study. Patients were randomized into 3 groups (n=15 each): group A, inhaled 100% O2 via face mask continuously for 5 min,after induction of anesthesia, patients were mechanically ventilated for another 3 min until tracheal intubation, ventilation parameter was set to: FiO2 = 100%, RR = 12bpm, Vt = 10 ml × standard weight (Kg); group B, inhaled 100% O2 via face mask with CPAP(6cm H2O) for 5 min,the ventilation parameter was the same as group A but with PEEP (6cm H2O); group C,all processing were the same as group A, but the oxygen concentration was adjusted to 60%.After induction and intubation,no patients were ventilated until SpO2 decreased to 93%.The apnea duration until SpO2 reached 97%, 95% and 93% were measured, the blood gas analyses were performed before oxygen inhalation (T1) and after intubation (T2), then we calculated Qs / Qt and PaO2/FiO2 at T2 time point. Stomach flatulence was evaluated by surgeons. Results Compared with groups A, The duration of SpO2 to 93% was significantly prolonged in group B (488.2±64.7s vs 590.2±92.6s, P <0.05). The duration in Group C was significantly shorter than groups A and B (P <0.05). Compared with groups A, Qs / Qt in groups B and C were significantly decreased(all P <0.05). There were no significant difference in duration of SpO2 97% to 93% between groups A ,B and C(P >0.05). PaO2/FiO2 in group C is the highest, followed by group B and group A(all P <0.05). The stomach flatulence score was increased significantly in group B (P <0.05). Conclusion Application positive pressure ventilation can reduce Intrapulmonary shunt and improve oxygen reserves significantly, but should be alert to the risk of stomach flatulence.
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