全麻诱导期持续气道内正压通气模式与常规模式预给氧效能的比较  

Comparison of preoxygenation efficacy between continuous positive airway pressure(CPAP)mode and conventional mode during induction of general anesthesia

作　　者：宋月娇 杨振 梁颖华 丁明 葛圣金 廖庆武 SONG Yue-jiao;YANG Zhen;LIANG Ying-hua;DING Ming;GE Sheng-jing;LIAO Qing-wu(Department of Anesthesia,Zhongshan Hospital(Xiamen Branch),Fudan University,Xiamen 361015,Fujian,China;Department of Anesthesia,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院麻醉科,厦门361015 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《中国临床医学》2022年第5期789-794,共6页Chinese Journal of Clinical Medicine

基　　金：复旦大学附属中山医院厦门医院孵化课题(KYYJ201905).

摘　　要：目的比较全麻诱导时持续气道内正压通气(continuous positive airway pressure,CPAP)模式与常规模式的预给氧效能。方法纳入2020年5月1日至2021年12月31日复旦大学附属中山医院厦门医院收治的81例拟行全麻患者,分为诱导前自主呼吸组(n=27)、诱导后压力支持辅助通气PSV组(n=26)、诱导前CPAP组(n=28)。比较3组预给氧后呼出氧浓度(FeO_(2))达到90%的时间;4 min无通气状态后的呼出氧浓度(FeO_(2))、动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2));插管时反流发生率;血流动力学变化。结果CPAP组FeO_(2)达到90%所需时间短于自主呼吸组(P=0.01),与PSV组比较差异无统计学意义。Cox比例风险回归显示,3组达到90%FeO_(2)所需时间与性别、年龄、BMI无相关性,与自主呼吸模式相比,CPAP模式的HR=0.430(95%CI 0.243~0.761;P=0.04);与PSV模式相比,CPAP模式的HR=0.810(95%CI 0.474~1.383;P=0.44)。CPAP组在4 min无通气状态下的PaCO_(2)低于自主呼吸组(P=0.03),与PSV组比较差异无统计学意义;在4 min无通气状态下FeO_(2)、PaO_(2)、插管反流发生率、术前与插管后血流动力学变化差异均无统计学意义。结论全麻诱导前CPAP模式预给氧较诱导前自主呼吸模式效能更高,所需时间更短,4 min无通气状态下PaCO_(2)更低,值得临床推广。Objective To compare the preoxygenation efficacy of continuous positive airway pressure(CPAP)mode and conventional mode during induction of general anesthesia.Methods From May 1st,2020 to December 31st,2021,81 patients who were treated in Zhongshan Hospital(Xiamen Branch),Fudan University were included,they were divided into spontaneous breathing group before induction(n=27),pressure support assisted ventilation PSV group after induction(n=26),and CPAP group before induction(n=28).To compare the time for fraction of expirated oxygen(FeO_(2))to reach 90%;FeO_(2),arterial blood oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2))in 4 min without ventilation;incidence of reflux during intubation;hemodynamic changes.Results The time required for FeO_(2) to reach 90%in the CPAP group was shorter than that in the spontaneous breathing group(P=0.01),and there was no significant difference compared with the PSV group.Cox proportional-hazard regression analysis showed that the time required to reach 90%FeO_(2) in the three groups was not significantly correlated with gender,age,and BMI.Compared with the spontaneous breathing mode,the CPAP mode was HR=0.430(95%CI 0.243-0.761;P=0.04);compared with PSV mode,the CPAP mode was HR=0.810(95%CI 0.474-1.383;P=0.44).The PaCO_(2) in the CPAP group was lower than that in the spontaneous breathing group at 4 minutes without ventilation(P=0.03),and there was no significant difference compared with the PSV group.There was no significant difference in the hemodynamic changes before and after intubation.Conclusion CPAP mode of pre-oxygenation before induction of general anesthesia is more effective than the spontaneous breathing mode before induction,the time required is shorter,and the PaCO_(2) is lower in the 4-min non-ventilation state.

关 键 词：持续气道内正压通气 预给氧 效能 

分 类 号：R614[医药卫生—麻醉学]