头高15°倾斜位吸氧去氮对肥胖患者耐受呼吸暂停安全时限的影响  

Effects of pre-oxygenation in the 15° head-up tilt position in obesepatients on duration of non-hypoxic apnoea

作　　者：但伶[1] 赵云[1] 李炜[1] 季道如[1] 陈玉培[1] 李小霞[1] 

机构地区：[1]重庆医科大学附属第二医院麻醉科,重庆400010

出　　处：《激光杂志》2011年第4期87-88,共2页Laser Journal

基　　金：重庆市卫生局基金资助项目(编号:2008-2-216)

摘　　要：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。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.

关 键 词：头高15°倾斜位:平卧位 肥胖患者 呼吸暂停安全时限 吸氧去氮 

分 类 号：R477[医药卫生—护理学]