俯卧位下地心引力及机械性干涉对脊柱手术呼吸功能影响的临床研究  

Gravitational and Mechanical Interference on the Respiratory Function During Spinal Surgery in Prone Position

作　　者：许太武[1] 丁玉兴[1] 李晓亮[1] 杨绍琴 杨志明[1] 刘王景[1] 李主一[1] 

机构地区：[1]解放军成都军区昆明总医院麻醉科

出　　处：《中华骨科杂志》1997年第4期252-254,共3页Chinese Journal of Orthopaedics

摘　　要：作者测定了５５例脊柱手术患者术前仰卧位、俯卧位，麻醉后俯卧位和术毕仰卧位的呼吸频率（ｆｒｅｑｕｅｎｃｙ，ｆ）、潮气量（ｔｉｄａｌｖｏｌｕｍｅ，ＶＴ）、每分通气量（ｍｉｎｕｔｅｖｏｌｕｍｅ，ＭＶ）、血氧饱和度（ｐｕｌｓｅｏｘｙｇｅｎｓａｔｕｒａｔｉｏｎ，ＳｐＯ２）和呼气终末ＣＯ２分压（ｅｎｄｔｉｄａｌＰＣＯ２，ＰｅｔＣＯ２）。结果发现，麻醉后俯卧位的ＶＴ、ＭＶ、ＳｐＯ２明显低于术前仰卧位（Ｐ值＜０．０５）；ｆ、ＰｅｔＣＯ２明显高于术前仰卧位（Ｐ值＜０．０５）。若改为先将患者置于手术体位，再麻醉，其呼吸功能则比较平稳（Ｐ值＞０．０５）。作者认为，俯卧位对呼吸功能的影响主要来自地心引力（重力）和机械干涉两方面因素。并提出：（１）此类手术应先将患者置于手术体位，再麻醉；（２）安置俯卧位时，应取髂前上棘、耻骨结节部和锁骨区为身体的负重点；（３）麻醉平面应控制在Ｔ６；（４）术中应常规吸氧；（５）慎用麻醉辅助药。For the investigation of the gravitational and mechanical interference on the respiratory function when the body position changed during spinal surgery, the respiratory frequency(f), tidal volume(VT), minute volume(MV), pulse oxygen saturation(SpO 2) and end tidal PCO 2(PetCO 2) were measured in 55 patients in prone and supine position pre and post anesthesia respectively. The results showed that VT, MV and SpO 2 were significantly lower in prone position after anesthesia, but f and PetCO 2 were higher than those in supine position pre anesthesia(P<0.05). On the contrary, if the patient was placed in the operation position first and then started the anesthesia, the respiratory changes were comparatively stable(P>0.05). The results suggested that the respiratory function in prone position was mainly affected by gravitation and mechanical factors. Therefore, the authors considered that it is advisable to place the patients in the surgery position first and start the anesthesia. In order to minimize the interference on the respiratory function, the clavicle and the ilium should be used as the fulcrum to avoid direct contact of chest and abdomen with the operation table. In addition, the anesthesia level should be controlled at lower than T 6, oxygen inhalation should be routinely given and the additional drug should be carefully administered during the operation.

关 键 词：呼吸功能 体位 引力 机械干涉 脊柱手术 

分 类 号：R687.4[医药卫生—骨科学]