摘要
目的观察全身麻醉诱导期连续气道正压通气(CPAP)联合头高位15°斜坡位预给氧方式对无通气安全时限的影响。方法择期全身麻醉手术患者80例,随机分为A、B、C和D组,每组20例。麻醉诱导前、后患者均为自主呼吸,不进行任何辅助或控制通气。诱导前2min开始面罩吸入纯氧,A组采取平卧位;B组采取头高15°斜坡位;C组采取平卧位,加用CPAP(6cmH2O,1cmH2O=0.098kPa);D组采取头高15°斜坡位,加用CPAP(6cmH2O)。麻醉诱导插管后,气管开放于空气。记录呼吸停止至SpO2降至90%的时间(无通气安全时限),然后再行机械通气。记录入室后(T1)、诱导后(T2)、插管后(T3)、SpO2降至90%时(T90)的血压、心率,分别于吸氧2min时(Tx)及SpO2降至90%时(T90)取动脉血行血气分析。术中观察胃胀气情况。结果B、C、D组无通气安全时限均较A组显著增长(P值均<0.05),D组又显著长于B、C组(P值均<0.05)。各组T2时间点的血压均显著低于T1时间点(P值均<0.05),但各组间的差异均无统计学意义(P值均>0.05)。D组T3时间点的平均动脉压显著低于A组(P<0.05)。不同时间点各组间心率的差异均无统计学意义(P值均>0.05)。4组均无胃胀气发生。结论全身麻醉诱导期头高位15°体位联合CPAP预给氧方式可进一步延长无通气安全时限。
Objective To observe the effect of continuous positive airway pressure （CPAP）combined with the 15° head-up tilt position during pre-oxygenation and induction of general anaesthesia on the duration of non-hypoxic apnea. Methods Eighty patients undergoing general anesthesia were enrolled in this study. Patients breathed spontaneously before and during induction. Two minutes before intravenous induction, patients began to inhale 100 %O2 via face mask continuously. Patients were then randomized into 4 groups （n=20 each）： group A inhaled oxygen in supine position; group B was in a 15° head-up tilt position; group C was in supine position with CPAP of 6 cmH2O （ 1 cmH20= 0. 098 kPa） ; group D was in a 15° head-up tilt position with OPAP of 6 cmH2O. After induction and intubation, no patients were ventilated until SpO2 decreased to 90%. The duration of non-hypoxic apnea （from breath stopping to SpO2 of 90% ） was recorded. Blood pressure and heart rate were monitored before oxygen inhalation （T1）, after induction （T2）, after intubation （T3） and at the time of SpO2 reaching 90% （T90）. Arterial blood gas analysis was performed before induction （after 2 min of oxygen inhalation） and at the time of SpO2 to 90% （T90）. Stomach inflation was observed by surgeons. Results The duration of non-hypoxic apnea was significantly longer in group B,C and D compared with in group A （all P〈0.05） ; the duration in group D was significantly longer compared with group B and C （both P〈0.05）. Blood pressure equally decreased in all the groups after induction. However, the blood pressure at T3 was significantly lower in group D than that in group A （ P〈0.05）. Heart rate was similar at various time points among the groups. There was no stomach inflation in all studied patients. Conclusion CPAP combined with the 15° head-up tilt position during induction of anesthesia can prolong the duration of non-hypoxic apnea without side-effects.
出处
《上海医学》
CAS
CSCD
北大核心
2009年第1期46-49,共4页
Shanghai Medical Journal
关键词
持续正压通气
头高位
预给氧
无通气安全时限
Continuous positive airway pressure
Position,head-up tilt
Apnea, non-hypoxic
Pre-oxygenation
