CAJ | 학술논문

目的;探讨全麻诱导插管期间,头高15°倾斜位与平卧位吸氧去氮两种给氧方式对肥胖患者耐受呼吸暂停安全时限的影响。方法：选择年龄21-63岁,BMI〉28 kg/m2,ASAI-II级择期手术的全麻插管病人62例。将其随机分为平卧位（30例）和头高15°倾斜位（32例）两组,常规静脉麻醉诱导,诱导期以10L/min的氧流量充分吸氧去氮4min,诱导结束行气管插管,插管完毕后继续脱氧观察,待脉搏氧饱和度（SpO2）降至90%时,接入麻醉机呼吸回路行控制呼吸。记录麻醉诱导末至SpO2下降到90%时刻的呼吸暂停时限,采集入室初、吸氧去氮后和SpO2降至90%时3个时间点的动脉血作血气分析。结果：肥胖患者头高15°倾斜位与平卧位吸氧去氮耐受呼吸暂停安全时限比较,头高15°倾斜位可明显延长患者耐受时限约70秒,两组有显著性差异（P〈0.05）。结论;肥胖患者头高15°倾斜位吸氧去氮较平卧位能明显延长呼吸暂停安全时限,降低麻醉风险。
목적;탐토전마유도삽관기간,두고15°경사위여평와위흡양거담량충급양방식대비반환자내수호흡잠정안전시한적영향。방법：선택년령21-63세,BMI〉28 kg/m2,ASAI-II급택기수술적전마삽관병인62례。장기수궤분위평와위（30례）화두고15°경사위（32례）량조,상규정맥마취유도,유도기이10L/min적양류량충분흡양거담4min,유도결속행기관삽관,삽관완필후계속탈양관찰,대맥박양포화도（SpO2）강지90%시,접입마취궤호흡회로행공제호흡。기록마취유도말지SpO2하강도90%시각적호흡잠정시한,채집입실초、흡양거담후화SpO2강지90%시3개시간점적동맥혈작혈기분석。결과：비반환자두고15°경사위여평와위흡양거담내수호흡잠정안전시한비교,두고15°경사위가명현연장환자내수시한약70초,량조유현저성차이（P〈0.05）。결론;비반환자두고15°경사위흡양거담교평와위능명현연장호흡잠정안전시한,강저마취풍험。
Objective：To investigate the effects of pre-oxygenation between 15° head-up tilt position and supine position in obese patients on duration of non-hypoxic apnoea during induction and intubation of anesthesia.Methods： 62 patients undergoing surgery with general anaesthesia aged 21-63 years old and BMI28 kg/m2 with ASAI-II grade and without special diseases were included.Participants were randomly allocated： Group 1（supine position,n=30） and Group 2（15° head-up tilt position,n=32）.Pre-oxygenation was achieved with an oxygen flow of 10 litre/min within 4 minutes.After rapid sequence induction of anaesthesia,the trachea was intubated and the patient was left apnoea and disconnected from the breathing system.The duration of apnoea was recorded as from the end of induction of anaesthesia to the time that SpO2 fell to 90%,at which point the obese patient was reconnected to the breathing system and ventilation was commenced with 100% inspired oxygen.Arterial blood samples were drew when patients to enter the operating room and the end of induction of anaesthesia and SpO2 fell to 90% respectively for arterial blood gas（ABG）analysis.Results：The duration of non-hypoxic apnoea in Group 2（15° head-up tilt position） were longer about 70 seconds than in Group l（supine position）.There were significantly differences between two groups（P0.05）.Conclusion： Pre-oxygenation is significantly more efficacious in the 15° head-up tilt position than in the supine position in obese patients.