国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2012年
1期
11-17
,共7页
赵鲁燕%蔡宏伟%任飞%郭曲练
趙魯燕%蔡宏偉%任飛%郭麯練
조로연%채굉위%임비%곽곡련
吸入氧浓度%氧储备%肺换气功能%无通气时限%肺内分流率
吸入氧濃度%氧儲備%肺換氣功能%無通氣時限%肺內分流率
흡입양농도%양저비%폐환기공능%무통기시한%폐내분류솔
Fraction of inspired oxygen%Oxygen reserve%Pulmonary gas exchange%Apnea tolerance%Intrapulmonary shunt
目的 在围麻醉期和危重患者的通气中,高浓度氧吸入可引起肺泡不张,肺内分流率增加,长时间应用可引起肺实质损害.研究观察术后麻醉恢复期不同吸入氧浓度通气对拔管前氧储备和肺换气功能的影响,为通气选择合适的吸入氧浓度提供依据. 方法 152例不吸烟的全麻择期手术患者,进入麻醉恢复室(post anesthesia care unit,PACU)后接呼吸机,通气模式为同步间歇指令通气,调节吸入氧浓度为35％,进行肺活量膨肺的肺复原操作,操作结束后,呼吸机调回同步间歇指令通气模式.根据完全随机的原则分为4组(每组38例):0.35吸入氧浓度(fraction of inspired oxygen in nitrogen,FiO2)组,0.50FiO2组,0.75FiO2组,1.0FiO2组.通气5 min,停止通气.当血氧饱和度下降至90％,接上呼吸机.穿刺抽取足背动脉血,并根据公式计算肺内分流率(Qs/Qt)和氧合指数(PaO2/FiO2). 结果 0.35FiO2组0.50FiO2组,0.75FiO2组和1.0FiO2组的无通气时限分别为(129 ±42)、(178±61)、(340±152)、(421±153)s(P＜0.001).1.0FiO2组的无通气时限高于0.75FiO2组,但差异无统计学意义.1.0FiO2组的无通气时限明显高于0.35FiO2组和0.50FiO2组(P＜0.005)；0.75FiO2组的无通气时限非常明显高于0.35FiO2组和0.50FiO2组(P＜0.005).0.50FiO2组的无通气时限高于0.35FiO2组,但差异无统计学意义.0.35FiO2组0.50FiO2组,0.75FiO2组的肺内分流率分别为(4.1±1.1)、(4.6±1.3)、(5.1±2.5)％,均明显低于1.0FiO2组(13.1±4.5)％(P＜0.001).0.35FiO2组,0.50FiO2组和0.75FiO2组氧合指数分别为(494±75)、(523±70)、(536±80),明显高于1.0FiO2组(423±94,P＜0.005). 结论 吸入0.75的氧能够改善肺换气功能,但无通气时限减少.
目的 在圍痳醉期和危重患者的通氣中,高濃度氧吸入可引起肺泡不張,肺內分流率增加,長時間應用可引起肺實質損害.研究觀察術後痳醉恢複期不同吸入氧濃度通氣對拔管前氧儲備和肺換氣功能的影響,為通氣選擇閤適的吸入氧濃度提供依據. 方法 152例不吸煙的全痳擇期手術患者,進入痳醉恢複室(post anesthesia care unit,PACU)後接呼吸機,通氣模式為同步間歇指令通氣,調節吸入氧濃度為35％,進行肺活量膨肺的肺複原操作,操作結束後,呼吸機調迴同步間歇指令通氣模式.根據完全隨機的原則分為4組(每組38例):0.35吸入氧濃度(fraction of inspired oxygen in nitrogen,FiO2)組,0.50FiO2組,0.75FiO2組,1.0FiO2組.通氣5 min,停止通氣.噹血氧飽和度下降至90％,接上呼吸機.穿刺抽取足揹動脈血,併根據公式計算肺內分流率(Qs/Qt)和氧閤指數(PaO2/FiO2). 結果 0.35FiO2組0.50FiO2組,0.75FiO2組和1.0FiO2組的無通氣時限分彆為(129 ±42)、(178±61)、(340±152)、(421±153)s(P＜0.001).1.0FiO2組的無通氣時限高于0.75FiO2組,但差異無統計學意義.1.0FiO2組的無通氣時限明顯高于0.35FiO2組和0.50FiO2組(P＜0.005)；0.75FiO2組的無通氣時限非常明顯高于0.35FiO2組和0.50FiO2組(P＜0.005).0.50FiO2組的無通氣時限高于0.35FiO2組,但差異無統計學意義.0.35FiO2組0.50FiO2組,0.75FiO2組的肺內分流率分彆為(4.1±1.1)、(4.6±1.3)、(5.1±2.5)％,均明顯低于1.0FiO2組(13.1±4.5)％(P＜0.001).0.35FiO2組,0.50FiO2組和0.75FiO2組氧閤指數分彆為(494±75)、(523±70)、(536±80),明顯高于1.0FiO2組(423±94,P＜0.005). 結論 吸入0.75的氧能夠改善肺換氣功能,但無通氣時限減少.
목적 재위마취기화위중환자적통기중,고농도양흡입가인기폐포불장,폐내분류솔증가,장시간응용가인기폐실질손해.연구관찰술후마취회복기불동흡입양농도통기대발관전양저비화폐환기공능적영향,위통기선택합괄적흡입양농도제공의거. 방법 152례불흡연적전마택기수술환자,진입마취회복실(post anesthesia care unit,PACU)후접호흡궤,통기모식위동보간헐지령통기,조절흡입양농도위35％,진행폐활량팽폐적폐복원조작,조작결속후,호흡궤조회동보간헐지령통기모식.근거완전수궤적원칙분위4조(매조38례):0.35흡입양농도(fraction of inspired oxygen in nitrogen,FiO2)조,0.50FiO2조,0.75FiO2조,1.0FiO2조.통기5 min,정지통기.당혈양포화도하강지90％,접상호흡궤.천자추취족배동맥혈,병근거공식계산폐내분류솔(Qs/Qt)화양합지수(PaO2/FiO2). 결과 0.35FiO2조0.50FiO2조,0.75FiO2조화1.0FiO2조적무통기시한분별위(129 ±42)、(178±61)、(340±152)、(421±153)s(P＜0.001).1.0FiO2조적무통기시한고우0.75FiO2조,단차이무통계학의의.1.0FiO2조적무통기시한명현고우0.35FiO2조화0.50FiO2조(P＜0.005)；0.75FiO2조적무통기시한비상명현고우0.35FiO2조화0.50FiO2조(P＜0.005).0.50FiO2조적무통기시한고우0.35FiO2조,단차이무통계학의의.0.35FiO2조0.50FiO2조,0.75FiO2조적폐내분류솔분별위(4.1±1.1)、(4.6±1.3)、(5.1±2.5)％,균명현저우1.0FiO2조(13.1±4.5)％(P＜0.001).0.35FiO2조,0.50FiO2조화0.75FiO2조양합지수분별위(494±75)、(523±70)、(536±80),명현고우1.0FiO2조(423±94,P＜0.005). 결론 흡입0.75적양능구개선폐환기공능,단무통기시한감소.
Background To observe the effects of different fractions of inspired oxygen(FiO2)during anesthesia recovery period on oxygen reserve and pulmonary gas exchange before extubation.Methods One hundred and fifty-two non-smoking patients with elective surgery done under general anesthesia were included in this study.After entering post anesthesia care unit (PACU),all the patients were mechanically ventilated with SIMV mode in FiO20.35.When a stable end-tidal oxygen concentration was achieved,a lung recruitment maneuver was performed and then the mode of ventilation went back to synchronized intermittent mandatory ventilation(SIMV).The patients were randomly assigned to 4 groups(n=38):FiO2=0.35,FiO2=0.5,FiO2=0.75,FiO2=1.0.The patients were ventilated with different concentrations of oxygen corresponding to their grouping for 5 min.The ventilator was stopped and the time of apnea tolerance was recorded.Blood samples were taken from dorsal artery of foot for blood-gas analysis.The shunt(Qs/Qt)and PaO2/FiO2 were calculated as well.Results The time to apnea tolerance were in turn(129±42),(178±61),(340±152),(421±153)s(P＜0.001)in group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2.Compared with group 0.75FiO2,apnea tolerance in group 1.0FiO2 was longer,but it was not statistically significant.Apnea tolerance in group 1.0FiO2 was significantly longer than in group 0.35FiO2 or group 0.50FiO2.Apnea tolerance in group 0.75FiO2 was significantly longer than in group 0.35FiO2 or group 0.50FiO2.Apnea tolerance in group 0.50FiO2 was longer than in group 0.35FiO2,which was not statistically significant.Shunt after apnea were in turn(4.1±1.1),(4.6±1.3),(5.1±2.5),(13.1±4.5)％ in group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2,respectively.Shunt in group 0.35FiO2,group 0.50FiO2 and 0.75FiO2 was significantly less than that in group 1.0FiO2(P＜0.001).PaO2/FiO2 after apnea were(494±75),(523±70),(536±80),(423±94)(P＜0.001)in the turn of group 0.35FiO2,group 0.50FiO2,group 0.75FiO2 and group 1.0FiO2.Pao2/FiO2 after apnea in group 0.35FiO2,group 0.50FiO2 and group 0.75FiO2 was significant larger than in group 1.0FiO2.Conclusions The use of 75％ oxygen can improve the pulmonary gas exchange,accompanied by shortened apnea tolerance.
