预氧非正压通气在腹腔镜手术全麻诱导期的应用  

Application of preoxygenated non-positive pressure ventilation during induction of general anesthesia in laparoscopic surgery

作　　者：马丽云 秦再生[1] 田珂[1] MA Li-yun;QIN Zaisheng;TIAN Ke(Department of Anesthesiology,Southern Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院麻醉科,广州510515

出　　处：《中国处方药》2020年第12期189-192,共4页Journal of China Prescription Drug

摘　　要：目的探讨预氧非正压通气用于腹腔镜手术全麻诱导期的安全性及减少胃胀气方面的有效性。方法采用双盲随机对照研究方法,选取2019年7月~2019年12月在南方医院行择期腹腔镜手术的99例患者,随机分为手控组(A组)、压控组(B组)、非正压组(C组),所有患者麻醉前均进行3 min预氧,采用丙泊酚和瑞芬太尼双通道靶控快速诱导,三组实施不同的辅助通气策略。记录并比较患者预氧前(T0)、预氧后(T1)、意识消失时(T2)、气管插管时(T3)、气管插管成功时(T4)的生命体征(HR、MAP、SpO2)和血气分析数值(PaO2、PaCO2、pH、HCO3-),比较三组患者的胃胀评分、术中留置胃管和诱导相关不良反应的发生率。结果在T3和T4,C组PaO_2和pH比A、B两组低(P <0.05),PaCO2比A、B两组高(P <0.05)。相较于T0,在T4时刻,三组的MAP和pH明显降低(P <0.05),SpO2、PaO2、PaCO2明显升高(P <0.05),而HCO3-只有C组有升高(P <0.05)。三组患者在相同时间点的HR、MAP、SpO2、HCO3-组间比较无明显差异(P> 0.05)。A、B两组胃胀评分比C组高(P <0.05);三组皆没有返流、呕吐、误吸等不良事件发生。结论预氧非正压通气可减少胃胀气的发生,气管插管成功后血气值和生命体征皆在安全允许范围之内。因此该方法在全麻腹腔镜手术中是安全有效的。Objective To investigate the safety and effectiveness of preoxygenation non-positive pressure ventilation in reducing gastric insufflation during induction of general anesthesia in laparoscopic surgery.Methods A randomized,double blind,controlled trial was performed.99 patients who underwent regular laparoscopic surgery in Nanfang Hospital from July 2019 to December 2019 were randomly divided into manual group(Group A),pressure-controlled group(Group B)and non-positive pressure group(Group C).All patients were preoxygenated for 3 minutes before induction and were quickly induced by propofol and rifen through dual-channel target-controlled injection.Different auxiliary ventilation strategies were implemented in three groups.Intubation was carried out one minute after muscle relaxant(rocuronium)was injected.The degree of gastric distension was observed under laparoscopy at the beginning of the operation.The outcomes of vital signs(HR,MAP,SpO2)and blood gas analysis values(PaO2,PaCO2,pH,HCO3-)were recorded and compared before preoxygenation(T0),after preoxygenation(T1),when consciousness disappeared(T2),when endotracheal intubation(T3),when endotracheal intubation finished(T4).The scores of gastric distension,the incidence of indwelling gastric tube and induction-related adverse reaction were compared among the three groups.Results At T3 and T4,the PaO2 and pH in Group C was lower than that in Group A and Group B(P<0.05),and the PaCO2 of Group C was higher than that in Group A and Group B(P<0.05).At t4,the MAP and pH of the three groups was lower than that of T0(P<0.05).SpO2,PaO2 and PaCO2 at T4 increased significantly than that at T0 in the three groups(P<0.05).While HCO3-increased only in Group C(P<0.05).There was no significant difference in HR,MAP,SpO2 and HCO3-among the three groups at the same time(P>0.05).The gastric insufflation score in Group A and Group B was higher than that in Group C(P<0.05).There were no adverse events such as reflux,vomiting and aspiration in the three groups.Conclusion Rapid inductio

关 键 词：预氧 非正压通气 腹腔镜 胃胀气 全身麻醉 

分 类 号：R614.2[医药卫生—麻醉学]