全身麻醉插管患者提升肺内氧浓度时适宜新鲜氧流量的探讨  

To explore the suitable fresh oxygen flow rate for the rise of lung oxygen concentration in patients under general anaesthesia with tracheal intubation

作　　者：刘海瑞[1] 常留辉[1] 顾晓蕾[1] 谢红[1] 

机构地区：[1]苏州大学附属第二医院麻醉科,215004

出　　处：《国际麻醉学与复苏杂志》2015年第7期627-630,共4页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨提升气管插管全身麻醉患者肺内氧浓度的适宜新鲜氧流量。方法选择择期患者60例，美国麻醉医师协会（ASA）分级Ⅰ-Ⅱ级，年龄18岁-60岁，体重指数18．5kg／m2-25．0kg／m2。采用全凭静脉麻醉，行容量控制机械通气。首先调节吸入氧浓度（inspired oxygen fraction，FiO2）为30％，分钟新鲜气体流量0．1L／kg。当患者呼出氧浓度（fractional concentration of expiredoxygen，FeO2）为30％时，开始提升患者肺内的氧浓度：依次调节分钟新鲜氧气流量（oxygenflowrate，FO2）为0．O2、0．04、0．06、0．08、0．10、0．12、0．14、0．16L／kg，同时将FiO2调至100％，比较不同FO2时患者FeO2从30％升至50％所需要的时间（t30%-50%），并计算每次所需要的新鲜氧气量（oxygenuptake，VO2），将FO2与VO2行Pearson相关分析。结果①当FO2分别以0．O2、0．04、0．06、0．08、0．10、0．12、0．14、0．16Ukg提升患者肺内氧浓度时，t30%-50%分别为181、97、68、58、53、49、47、44s。②当FO2分别为0．O2、0．04、0．06L／kg时，t30%-50%减少明显，两两比较差异有统计学意义（P〈0．01）。FO20．08L／kg-0．16L／kg与FO20．O2L／kg-0．06L／kg比较，以及FO20．16L／kg与FO2O．08L／kg比较，t30%-50%。均明显减少（P〈0．01）。③FO2与VO2相关性显著，相关系数1-=-0．864（P〈O．01o结论当气管插管全身麻醉患者FeO2为30％时，选择FO20．08L／kg～0．10L／kg可快速提升FeO2至50％，同时又避免了新鲜氧气的过多浪费。Objective To explore the suitable fresh oxygen flow rate for the rise of lung oxygen concentration in patients under general anaesthesia with tracheal intubation. Methods Sixty ASA Ⅰ-Ⅱ patients, aged 18 y-60 y, BMI 18.5 kg/m2-25.0 kg/m2, scheduled for elective surgery under total intravenous anesthesia and volume control mechanical ventilation,were enrolled in this study. Firstly, the fraction concentration of inspired oxygen （FiO2） was adjusted to 30% and the minite flesh gas flow rate 0,1 L/kg. Preoxygenation was undertaken when the fractional concentration of expired oxygen （FeO2） reached 30%： The minite flesh oxygen flow rate （FO2） was adjusted to 0.02, 0.04, 0.06, O.08, 0.10, 0.12, 0.14 I./kg and 0.16 ldkg in turn and FiO2 was adjusted to 100%. The times of rised FeO2 from 30% to 50%（t30%-50%） was compared under different FO2, the required flesh oxygen volume under different FO2 was calculated, and pearson correlation between FO2 and oxygen uptake （VO2） was analyzed. Results （1） t30%-50% was respectively 181, 97, 68, 58, 53, 49, 47 s and 44 s when the oxygen concentration in the lung was respectively increased in a FO2 of 0.02, 0.04, 0.06, 0.08, 0.1, 0.12, 0.14 L/kg and 0.16 L/kg. （2） There was significant decreases in different t30%-50% when FO2 was 0.02,0.04 L/kg and 0.06 L/kg （P〈0.01）, There was significant decrease between t30%-50% when FO2 was 0.02 L/kg-0.06 L/kg and 0.08 L./kg-0.16 L/kg （P〈0.01）, significant difference also existed between t30%-50% when FO2 was 0.08 L/kg and 0.16 L/kg （P〈 0.01 ）. （3） The change in VO2 was positively correlated with FO2 （r=0.864, P〈0.01 ）. Conclusions FO2 of 0.08 L/kg-0.10 L/kg can rapidly increase the FeO2 from 30% to 50% for patients under general anaesthesia with tracheal intubation, while not too much flesh oxygen is required.

关 键 词：麻醉 全身 氧浓度 氧流量 

分 类 号：R614.2[医药卫生—麻醉学]