摘要
目的研究给氧方式对全麻插管安全时限的影响。方法妇科手术患者75例,按诱导给氧方式随机均分为三组:A组,潮气量呼吸3min后行快速顺序诱导(RSI);B组,30s内深呼吸4次后行RSI;C组,常规诱导正压通气。所有患者的吸入氧流量均为5L/min。气管插管后待SpO2降至90%再迅速连接导管和麻醉机进行手控正压通气。记录各组无通气安全时间、气管插管时间、观察期内最低SpO2和最高PETCO2。每组随机选8例分别在诱导前、停通气即刻、SpO2降至90%时采动脉血进行血气分析。插管安全时限在C组即为无通气安全时间,在A、B组则为无通气安全时间减60s肌松起效时间。结果A组无通气安全时间为(471.9±100.9)s,明显长于B组的(359.0±95.7)s和C组的(378.1±109.2)s(P<0.05),插管安全时限A组为(411.9±134.8)s,C组为(378.1±109.2)s,均明显长于B组[(299.8±95.7)s](P<0.05),三组实际插管时间超过50s的共3例,均没有超过各组插管安全时限的最低值。结论潮气量呼吸预给氧3min后行RSI与常规诱导面罩正压通气所获得的插管安全时限是相同的,情况紧急时30s内深呼吸4次行RSI尽管插管安全时限比常规诱导短,但也能满足绝大多数患者的插管要求。
Objective To study the effect of oxygenation techniques during anesthesia induction on the safety period for tracheal intubation, Methods Seventy-five patients undergoing gynecological surgery were randomly assigned to three groups of A [rapid sequence induction （RSI） after tidal volume breathing for 3 mini, B （RSI after 4 times of deep breathing in 30 s）, or C （traditional induction with positive-pressure ventilation by mask）. An oxygen flow of 5 L/min was used for all patients. After intubation, the trachea disconnected from the anesthesia circuit until SpO2 decreased to 90%. The safety apnoea period （the time from the beginning of apnoea to SpO2 90%）, the time of tracheal intubation, the minimum of SpO2 and the maximum of PETCO2 during observation period were recorded. Three arterial blood gas samples were taken from 8 patients randomly selected from each group at the time points of before induction, the beginning of apnoea, and time of SpO2 90%. The apnoea period in group C was taken as the safety period for tracheal intubation, which was the value minus 60 s in groups of A and B. Results The safety apnoea period in group A was significantly longer than that in group B and C[（471.9±100. 9）s vs. （359.0±95.7 s） and （378.1±109.2）s]（P〈0. 05）. The safety period for tracheal intubation was shorter in group C than that in group A and B [（299.8±95.7）s vs. （411.9±134. 8）s and（378.1±109.2） s] （P〈0. 05）. There were 3 patients in whom the intubation time exceeded 50 s, but no one exceed the minimum of the safety intubation period. Conclusion RSI after 3 min of tidal volume breathing with oxygen may provide a same safety intubation period as traditional induction with positive-pressure ventilation by mask. In case of emergency, the safety intubation period for RSI after 4 times of deep breathing in 30 s is shorter than that after traditional ventilation,which is still enough for tracheal intubation in the majority.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2009年第7期587-590,共4页
Journal of Clinical Anesthesiology
关键词
快速顺序诱导
预给氧
正压通气
Rapid sequence induction
Preoxygenation
Positive-pressure ventilation
