异丙酚对无痛人工流产术病人呼吸力学的影响  

The influence of propofol on respiratory mechanics during painless induced abortion

作　　者：石嵩[1] 张炳熙[1] 

机构地区：[1]首都医科大学附属北京同仁医院麻醉科,100730

出　　处：《中华麻醉学杂志》2004年第10期745-747,共3页Chinese Journal of Anesthesiology

摘　　要：目的 观察异丙酚对人工流产病人呼吸气体流速的影响,以期将异丙酚对呼吸的抑制程度进行量化描述。方法 择期行无痛人流术的早期妊娠病人40例,ASA Ⅰ级,异丙酚静脉麻醉。首次剂量为2.5 mg/kg,根据术中情况静脉追加30-50 mg。监测脉率及脉搏血氧饱和度。热线风速仪参数设定为:采样频率100 Hz,时间81.96 s。在麻醉前、后分别采样。观察每例病人麻醉前、后脉率、血氧饱和度、呼吸暂停发生率、及吸气、呼气相平均及气流最大速度、气体流量及动压、呼吸频率及平均每次吸气、呼气时间等呼吸力学相关指标。结果 与麻醉前比较,异丙酚麻醉后血氧饱和度下降(P<0.01),吸气、呼气相平均及气流最大速度、气体流量及动压下降(P<0.05),其中吸气相的改变尤其明显(P<0.01),呼吸频率增加(P<0.01),平均每次吸气、呼气时间缩短(P<0.01)。结论 异丙酚静脉麻醉后病人呼吸气流速度、流量及气体动压均降低,尤以吸气相更为明显。Objective Propofol has profound influence on respiration. The purpose of this study was to evaluate the effect of propofol on respiratory mechanics during painless induced abortion. Methods Forty ASA Ⅰ women in early pregnancy (45-60 days) aged 17-52 yrs, weighing 42-80 kg undergoing induced abortion were enrolled in this study. Anesthesia was induced with intravenous 2.5 mg·kg-1 and maintained with intermittent i.v. boluses of propofol 30-50 mg. SpO2 and HR were monitored with Nellcor N-180 pulse oximeter. Respiratory mechanics was monitored with IFA-300 anemometer (TSI Co. USA) . The parameters measured included inspiratory / expiratory maximal air-flow velocity, inspiratory / expiratory mean air flow velocity, mean inspiratory and expiratory time, respiratory rate, inspiratory / expiratory air flow volume, dynamic inspiratory and expiraory airway pressure and indidence of apnea.Results SpO2 decreased significantly during maintenance of anesthesia with propofol. The mean and maximal inspiratory / expiratory airflow velocity and the inspiratory / expiratory airflow volume all decreased significantly during propofol anesthesia. The dynamic inspiratory / expiratory airway pressure significantly decreased during propofol anesthesia. The respiratory rate was significantly higher during propofol anesthesia while the mean inspiratory /expiratory time became shorter. Three patients developed apnea during induction of anesthesia with propofol (7.5%) . Spontaneous breathing returned within 1 min. Conclusion Spontaneous breathing is significantly depressed during propofol anesthesia in terms of respiratory mechanics. Care should be taken to maintain oxygenation and ventilation of the patient.

关 键 词：异丙酚 病人 麻醉 呼吸力学 吸气 脉率 呼气相 最大速度 目的观 结论 

分 类 号：R169.42[医药卫生—公共卫生与预防医学] R614