机构地区：[1]江苏省原子医学研究所附属江原医院,无锡214063
出 处：《新医学》2023年第9期666-670,共5页Journal of New Medicine
基 金：江苏省原子医学研究所所青年基金(QN202005)。
摘 要：目的探究全身麻醉诱导后无通气期间不同氧浓度对肥胖患者氧合指数的影响。方法选择ASA分级Ⅱ~Ⅲ级的年龄18~65岁的肥胖患者(30 kg/m^(2)<BMI<40 kg/m^(2))75例,根据麻醉诱导期吸入氧浓度将其分为H组、M组、L组,按照理想体重给予诱导药物,待患者睫毛反射消失、自主呼吸停止后,放置口咽通气道,双手托下颌扣紧面罩机械通气预给氧(H组采用100%氧浓度,M组采用80%氧浓度,L组采用60%氧浓度),在可视光棒引导下行气管插管,暂不连接氧气,待氧饱和度降至92%时连接呼吸机。主要结局指标包括无通气期间患者麻醉诱导前(T_(0))、预给氧后(T_(1))、入麻醉复苏室前(T_(2))的氧合指数。次要结局指标包括T_(0)、T_(1)、T_(2)各时间点肺不张的发生例数;经皮血氧饱和度(SpO_(2))下降至92%的时间(开始插管至SpO_(2)降至92%的时间)、连接呼吸机后SpO_(2)恢复至100%的时间、插管时间及手术时间;患者术后肺部并发症发生率及住院时间。结果与H组相比,M组及L组T_(1)时间点氧合指数降低(P<0.05);与H组患者相比,T_(1)、T_(2)时间点M组及L组肺不张的发生率降低(P<0.05);3组患者中H组SpO_(2)下降至92%的时间为(197±57)s,M组为(157±31)s,L组为(131±23)s,与H组相比,M组及L组患者SpO_(2)下降至92%的时间均更短(P均<0.05)。H组SpO_(2)恢复至97%的时间短于M组与L组(P均<0.05)。3组患者的术后肺部并发症发生率及住院时间比较差异均无统计意义(P均<0.05)。结论肥胖患者全身麻醉诱导期间给予100%氧浓度时的氧合指数高于80%与60%氧浓度,有利于给氧后SpO_(2)的恢复,且3种给氧浓度术后肺部并发症发生率及住院时间无差异。Objective To evaluate the effects of different oxygen concentrations on the oxygenation index of obese patients during the non-ventilation period after general anesthesia induction.Methods 75 American Society of Anaesthesiologists(ASA)gradeⅡ-Ⅲobese patients(30 kg/m^(2)<body mass index(BMI)<40 kg/m^(2)),aged 18-65 years,were recruited and divided into H,M and L groups according to the inhaled oxygen concentration during anesthesia induction.Induction drugs were given according to the ideal body weight.After the patients’eyelash reflex were absent and spontaneous respiration was terminated,the oropharyngeal airway was placed,the mandibular mask was supported with both hands and mechanical ventilation was pre-administered with oxygen(100%oxygen concentration in group H,80%oxygen concentration in group M,and 60%oxygen concentration in group L).The tracheal tube was intubated under the guidance of a visual light rod,and oxygen was temporarily not connected.The ventilator was connected when O_(2)saturation declined to 92%.The main outcome indexes included the oxygenation index of obese patients before anesthesia induction(T_(0)),after preoxygenation(T_(1)),and before PACU entry(T_(2)).The secondary outcome indexes included the number of cases of attasis at each time point of T_(0),T_(1),and T_(2).The time of SpO_(2)decreasing to 92%(time interval between SpO_(2)decreasing to 92%and the start of intubation),the time of SpO_(2)restoring to 100%after ventilator connection,intubation time and operation time were recorded.The incidence of postoperative pulmonary complications and the length of hospital stay were compared among different groups.Results Compared with group H,oxygenation indexes at T_(1)were lower in groups M and L(both P<0.05).At T_(1)and T_(2),the incidence of atelectasis in groups M and L was significantly lower than that in group H(both P<0.05).Among the three groups,the time of SpO_(2)declining to 92%in group H was(197±57)s,(157±31)s in group M,and(131±23)s in group L,respectively.Compared with g
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