全身麻醉患者氧耗变化的临床观察  

Changes in oxygen consumption induced by general anesthesia

作　　者：洪方晓[1] 仇焕容[1] 岳郅劼 金沐 薛富善 HONG Fang-xiao;QIU Huan-rong;YUE Zhi-jie(Department of Anesthesiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,北京100050

出　　处：《临床和实验医学杂志》2020年第21期2347-2350,共4页Journal of Clinical and Experimental Medicine

基　　金：首都医科大学附属北京友谊医院科研启动基金(编号:yyqdkt2018-35)。

摘　　要：目的观察在氧供(DO2)充足情况下全身麻醉患者氧耗(VO2)的变化。方法前瞻性纳入首都医科大学附属北京友谊医院2019年11月至12月收治的18例美国麻醉医师协会(ASA)分级Ⅰ~Ⅱ级,择期行全身麻醉下腹腔镜结肠癌根治术患者。手术前1 d置入锁骨下静脉导管,麻醉诱导前行桡动脉穿刺置管,后连接连续心排量系统,记录麻醉诱导前(T0)以及诱导后10 min(T1)、20 min(T2)、30 min(T3)、40 min(T4)、50 min(T5)、60 min(T6)各个时间点的平均动脉压(MAP)、心率(HR)、心输出量(CO)、每搏量变异度(SVV)和麻醉深度指数(BIS)等资料,同时在各个时间点抽取中心静脉血样与动脉血样,进行血气分析,根据各时间点的血气结果计算DO2、VO2数值。结果全身麻醉诱导后患者的VO2呈双相性改变。诱导后初期,VO2呈轻度降低趋势,但很快急剧升高,于麻醉诱导后20 min左右达到峰值,随后缓慢下降,至诱导后50、60 min左右时稳定在一个较低水平。与T1相比,T2时VO2明显增加,差异有统计学意义(P=0.049);与T2相比,T5、T6时间点的VO2明显下降,差异有统计学意义(P=0.002、0.001)。结论在DO2充足的条件下,全身麻醉后患者的VO2呈双相性改变,即初期增加,20 min后开始降低,在接近1 h左右趋于平稳。Objective To observe the changes of oxygen consumption(VO2)in patients with oxygen uptake(DO2)supply after induction of anesthesia.Methods From November to December 2019,18 patients of American Society of Anesthesiologists(ASA)gradesⅠtoⅡundergoing elective laparocolectomy in general anesthesia were selected prospectively from Beijing Friendship Hospital,Capital Medical University.Central venous catheter was preoperatively placed.Invasive radial pressure monitoring was established before anesthesia induction and connected with a continuous cardiac output monitoring system.All parameters were recorded before anesthesia was initiated and after each 10 min,including mean arterial pressure(MAP),heart rate(HR),cardiac output(CO),stroke volume variation(SVV),anesthesia depth index(BIS)and other data.Central venous blood and arterial blood samples were taken simultaneously during the peri-intubation and peri-incision periods for blood gas analysis and for measurements of arterial and venous oxygen contents in order to DO2,VO2 according to the fick formula.Results General anesthesia reduces the global oxygen consumption.And then the oxygen consumption increased soon after about 10 min,reached maximum at about20 minutes after induction of anesthesia,and then slowly stabilized at a low level(about 50 and 60 min after induction).Compared with T1,the oxygen consumption increased significantly at T2,P=0.049;compared with T2,the oxygen consumption at time points T5 and T6 decreased significantly(P=0.002,0.001,respectively).Conclusion After induction of general anesthesia,it was demonstrated that a noteworthy elevation of global oxygen consumptions after above reduction,and then a significant drop during the peri-intubation and peri-incision periods,instead of just reduction.

关 键 词：全身麻醉 氧耗 氧供 

分 类 号：R614[医药卫生—麻醉学]