摘要
目的探讨不同FiO2对行腹腔镜胃减容术的病态肥胖患者肺氧合和呼吸力学的影响。方法选择择期行腹腔镜胃减容术的病态肥胖患者99例。采用随机数字表法分为3组,全身麻醉插管后维持FiO240%(L组,33例)、FiO260%(M组,33例)、FiO280%(H组,33例),直至手术结束。于未吸氧前(T0)、达目标氧浓度后5 min(T1)、气腹后1 h(T4)、气腹结束后5 min(T5)、入PACU后10 min(T6)、出PACU时(T7)采集桡动脉血进行血气分析,记录并计算氧合指数(oxygenation index,PaO2/FiO2)、动脉肺泡氧分压比(arterial/alveolar oxygen partial pressure ratio,a/APO2)、PaCO2;记录T1、气腹后5 min(T2)、气腹后30 min(T3)、T4、T5时刻气道平台压(plateau airway pressure,Pplat)、气道峰压(peak airway pressure,Ppeak)、动态肺顺应性(dynamic lung compliance,Cdyn);记录停药开始到拔管的时间、PACU停留时间、高氧血症(术中PaO2>300 mmHg,1 mmHg=0.133 kPa)和去氧饱和发生情况(术中SpO2<95%的例数、拔管后5 min SpO2下降至92%的例数及时长、PACU内SpO2<92%的例数)、不良事件发生情况(PACU内恶心呕吐、需应用口咽通气道或无创正压通气)、术后住院天数。结果3组患者一般资料差异无统计学意义(P>0.05)。与M组比较,L组、H组PACU停留时间延长(P<0.05),其余临床特征资料差异无统计学意义(P>0.05);H组T6、T7时点PaO2/FiO2较L组、M组降低(P<0.05),T4时点PaO2/FiO2、T6时点PaCO2较L组升高,T5时点Cdyn较L组降低(P<0.05),高氧血症的发生率较L组、M组升高(P<0.05);3组T0、T1、T5时点PaO2/FiO2、PaCO2,T0、T1、T4~T7时点a/APO2,T1~T4时点Cdyn,T1~T5时点Pplat、Ppeak差异无统计学意义(P>0.05)。与T0时点比较,3组T1、T4、T6、T7时点及L组T5时点PaO2/FiO2降低(P<0.05),3组T1、T4~T7时点a/APO2降低、PaCO2升高(P<0.05)。与T6时点比较,3组T7时点PaO2/FiO2、a/APO2、PaCO2差异无统计学意义(P>0.05)。与T1时点比较,3组T2~T5时点Pplat、Ppeak升高(P<0.05),Cdyn降低(P<0.05);与T4时点比较,3组T5时点Pplat、Ppeak降低(P<0.05),Cdyn升高(P<0.05)。3组去氧饱和及不良事件的发生情况差异无统计学意义(P>0.05)。结论与40%、80%的FiO2相比,行腹腔镜胃减容术的病态肥胖患者术中给予60%的FiO2对肺氧合和呼吸力学的优化是有效的,同时能够降低高氧血症的发生率且不增加去氧饱和及不良事件的发生风险。
Objective To investigate the effects of different fractions of inspired oxygen(FiO2)on the pulmonary oxygenation and respiratory mechanics in morbidly obese patients undergoing laparoscopic bariatric surgery.Methods A total of 99 morbidly obese patients who were scheduled for laparoscopic bariatric surgery were selected.According to the random number table method,they were divided into three groups and maintained the following treatment after intubation under general anesthesia until the end of surgery:FiO240%(group L,n=33),FiO260%(group M,n=33)and FiO280%(group H,n=33).Before oxygenation(T0),5 min after reaching the target oxygen concentration(T1),1 h after pneumoperitoneum(T4),5 min after the end of pneumoperitoneum(T5),10 min after entry into postanesthesia care unit(PACU)(T6)and discharge from PACU(T7),radial artery blood was collected to conduct blood gas analysis,and the oxygenation index(PaO2/FiO2),arterial/alveolar oxygen partial pressure ratio(a/APO2),and partial pressure of ar-tery carbon dioxide(PaCO2)were recorded and calculated.The plateau pressure(Pplat),peak airway pressure(Ppeak),and pulmonary dynamic compliance(Cdyn)were recorded at T1,5 min after pneumoperitoneum(T2),30 min after pneumoperitoneum(T3),T4 and T5.The duration from drug withdrawal to extubation,the length of PACU stay,hyperoxia[partial pressure ofoxygen(PaO2)>300 mmHg dur-ing surgery,1 mmHg=0.133 kPa]and oxygen desaturation events[percutaneous oxygen saturation(SpO2)<95%during surgery,the num-ber and duration when SpO2 dropped to 92%within 5 min after extubation,and SpO2<92%during PACU],adverse events(nausea and vomiting in PACU,need to apply oropharyngeal airway or non-invasive positive pressure ventilation),and the length of postoperative hospital stay were recorded.Results There were no significant differences in general data among the three groups(P>0.05).Com-pared with group M,the length of PACU stay prolonged in groups L and H(P<0.05),and there were no significant differences in other clinical characteristic data(P>0.05).Group H produced lower PaO2/FiO2 at T6‒T7 than groups L and M(P<0.05).Group H produced higher PaO2/FiO2 at T4,lower Cdyn at T5,and higher PaCO2 at T6 than group L(P<0.05).The incidence of hyperoxia in group H was higher than those in groups L and M(P<0.05).There were no significant differences in PaO2/FiO2 and PaCO2 at T0,T1,and T5,a/APO2 at T0,T1 and T4‒T7,Cdyn at T1‒T4,Pplat and Ppeak at T1‒T5 among the three groups(P>0.05).Compared with those at T0,decreased PaO2/FiO2 was found in the three groups at T1,T4,T6,T7 and in group L at T5,while decreased a/APO2 and increased PaCO2were seen in the three groups at T1 and T4‒T7(P<0.05).Compared with those at T6,there were no significant differences as to PaO2/FiO2,a/APO2,and Pa-CO2 in the three groups at T7(P>0.05).Compared with those at T1,the three groups produced increased Pplat and Ppeak(P<0.05)and decreased Cdyn at T2‒T5(P<0.05).Compared with those at T4,the three groups produced decreased Pplat and Ppeak(P<0.05)and in-creased Cdyn at T5(P<0.05).There were no significant differences in oxygen desaturation and adverse events among the three groups(P>0.05).Conclusions Compared with 40%and 80%FiO2,ventilation with 60%FiO2 is effective in optimizing the pulmonary oxygen-ation and respiratory mechanics in morbidly obese patients undergoing laparoscopic bariatric surgery,reduce the incidence of hyperoxe-mia without increasing the risk of oxygen desaturation and adverse events.
作者
孟香弟
黄晶晶
王涛
陈秀侠
Meng Xiangdi;Huang Jingjing;Wang Tao;Chen Xiuxia(Jiangsu Province Key Laboratory of Anesthesiology,Jiangsu Provincial Key Laboratory of Anesthesia and Analgesia Application Technol⁃ogy,Xuzhou Medical University,Xuzhou 221004,China;Department of Anesthesiology,the Affiliated Hospital of Xuzhou Medical Uni⁃versity,Xuzhou 221002,China)
出处
《国际麻醉学与复苏杂志》
CAS
2020年第5期469-474,共6页
International Journal of Anesthesiology and Resuscitation
关键词
吸入氧浓度
病态肥胖
腹腔镜治疗
胃减容术
肺氧合
呼吸力学
Fraction of inspired oxygen
Morbidly obese
Therapeutic laparoscopy
Bariatric surgery
Pulmonary oxy‐genation
Respiratory mechanics
