围手术期吸入高浓度氧的争议与思考  

Controversy and consideration of high concentration oxygen inhalation in perioperative period

作　　者：朱莹 陈小萍 高巨 Zhu Ying;Chen Xiaoping;Gao Ju(Department of Anesthesiology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China;Department of Anes-thesiology,Affiliated Clinical Medical College of Yangzhou University,Northern Jiangsu People′s Hospital,Yangzhou 225001,China)

机构地区：[1]河北北方学院附属第一医院麻醉科,张家口075000 [2]扬州大学临床医学院,江苏省苏北人民医院麻醉科,225001

出　　处：《国际麻醉学与复苏杂志》2021年第12期1308-1313,共6页International Journal of Anesthesiology and Resuscitation

基　　金：扬州市科技计划项目(YZ2019145)。

摘　　要：在全身麻醉过程中,特别是在气管插管和拔管之前,使用较高的FiO2是一种常见做法。近年来,对围手术期是否应该使用高浓度氧的争议越来越大。文章综述了高浓度氧在围手术期使用的利弊,围绕围手术期使用高浓度氧的不利影响,即活性氧(reactive oxygen species,ROS)引起的氧化应激增加、导致组织氧合受损的高氧性血管收缩和吸收性肺不张等,分别从高氧病理生理机制及临床研究数据两个方面展开讨论;也探讨了使用高浓度氧的益处,包括减少外科手术部位感染(surgical site infection,SSI)与术后恶心呕吐(postoperative nausea and vomiting,PONV)的发生,增加术中紧急情况下的缺氧耐受时间。It is a common manipulation to use higher fraction of inspiratory oxygen(FiO2)during general anesthesia,especially before endotracheal intubation and extubation.In recent years,there has been growing controversy over whether high levels of oxygen should be used in the perioperative period.This review summarizes the advantages and disadvantages of using high concentration oxygen in perioperative period,and discusses the adverse effects of using high concentration oxygen in perioperative period,including increased oxidative stress caused by reactive oxygen species(ROS),hyperoxygenated vasoconstriction and absorptive atelectasis resulting in impaired tissue oxygenation.The pathophysiological mechanism and clinical data of hyperoxia were summarized.In addition,the benefits of perioperative hyperoxia were stated:decreased incidence of surgical site infection(SSI),decreased postoperative nausea and vomiting(PONV),and increased tolerance time of postoperative hypoxia in emergency situations.

关 键 词：吸入氧浓度 高氧血症 活性氧 手术部位感染 肺损伤 术后肺部并发症 

分 类 号：R614[医药卫生—麻醉学]