国际麻醉学与复苏杂志   2015, Issue (7): 11-11
    
全麻插管患者提升肺内氧浓度时适宜新鲜氧流量的探讨
刘海瑞, 常留辉, 顾晓蕾, 谢红1()
1.苏州大学附属第二医院
To explore the suitable fresh oxygen flow rate for the rise of lung oxygen concentration in patients under general anaesthesia with tracheal intubation
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摘要:

目的 探讨提升气管插管全麻患者肺内氧浓度的适宜新鲜氧流量。方法 选择择期患者60例,ASA分级Ⅰ级或Ⅱ级,年龄18 ~ 60岁,体重指数18.5 ~ 25。采用全凭静脉麻醉,行容量控制机械通气。首先调节吸入氧浓度(FiO2)为30%,分钟新鲜气体流量0.1 L/kg。当患者呼出氧浓度(FeO2)为30%时,开始提升患者肺内的氧浓度:依次调节分钟新鲜氧气流量(FO2)为0.02 L/kg、0.04 L/kg、0.06 L/kg、0.08 L/kg、0.1 L/kg、0.12 L/kg、0.14 L/kg和0.16 L/kg,同时将FiO2调至100%,比较不同FO2时患者FeO2从30%升至50%所需要的时间(t30% ~ 50%),并计算每次所需要的新鲜氧气量(VO2),将FO2与VO2行Pearson相关分析。结果 ①当FO2分别以0.02 L/kg、0.04 L/kg、0.06 L/kg、0.08 L/kg、0.1 L/kg、0.12 L/kg、0.14 L/kg和0.16 L/kg提升患者肺内氧浓度时,t30% ~ 50%分别为181 s、97 s、68 s、58 s、53 s、49 s、47 s和44 s。②当FO2分别为0.02 L/kg、0.04 L/kg和0.06 L/kg时,t30% ~ 50%逐步减少,两两比较差异有统计学意义(P均 <0.01)。FO2 0.08 ~ 0.16 L/kg与FO2 0.02 ~ 0.06 L/kg比较,以及FO2 0.16 L/kg与FO2 0.08 L/kg比较,t30% ~ 50%均明显减少(P <0.01)。③FO2与VO2相关性显著,相关系数r = 0.864(P <0.01)。结论 当气管插管全麻患者呼出氧浓度为30%时,选择FO2 0.08 ~ 0.1 L/kg可快速提升呼出氧浓度至50%,同时又避免了新鲜氧气的过多浪费。

关键词: 全身麻醉;氧浓度;氧流量
Abstract:

Objective To explore the suitable fresh oxygen flow rate for the rise of lung oxygen concentration in patients under general anaesthesia with tracheal intubation. Methods Sixty ASA I or II patients, aged 18 ~ 60yr, BMI 18.5 ~ 25, scheduled for elective surgery under total intravenous anesthesia and volume control mechanical ventilation,were enrolled in this study. Firstly, the fraction concentration of inspired oxygen(FiO2)was adjusted to 30% and the minite flesh gas flow rate 0.1L/kg. Preoxygenation was undertaken when the fractional concentration of expired oxygen(FeO2) reached 30%: The minite flesh oxygen flow rate(FO2) was adjusted to 0.02 L/kg、0.04 L/kg、0.06 L/kg、0.08 L/kg、0.1 L/kg、0.12 L/kg、0.14 L/kg and 0.16 L/kg in turn and FiO2 was adjusted to 100%. The times of rised FeO2 from 30% to 50%(t30% ~ 50%) was compared under different FO2,.the required flesh oxygen volume under different FO2 was calculated, and Pearson correlation between FO2 and VO2 was analyzed. Results ①t30% ~ 50% was respectively 181 s, 97 s, 68 s, 58 s, 53 s, 49 s, 47 s and 44 when the oxygen concentration in the lung was respectively increased in a FO2 of 0.02 L/kg, 0.04 L/kg, 0.06 L/kg, 0.08 L/kg, 0.1 L/kg, 0.12 L/kg, 0.14 L/kg and 0.16 L/kg. ②There was significant decreases in different t30% ~ 50% when FO2 was 0.02 L/kg、0.04 L/kg and 0.06 L/kg(P <0.01); There was significant decrease between t30% ~ 50% when FO2 was 0.02 ~ 0.06 L/kg and 0.08 ~ 0.16 L/kg(P <0.01), significant difference also existed between t30% ~ 50% when FO2 was 0.08 L/kg and 0.16 L/kg(P <0.01). ③The change in VO2 was positively correlated with FO2(r = 0.864,P <0.01). Conclusion A FO2 of 0.08 ~ 0.1 L/kg can rapidly increase the FeO2 from 30% to 50% for patients under general anaesthesia with tracheal intubation, while not too much flesh oxygen is required.

Key words: general anaesthesia;oxygen concentration;oxygen flow rate