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| 头高15°倾斜位对肥胖患者全麻苏醒期呼吸功能的影响 |
| Effect of 15° head up tilt position on quality of respiratory system during anesthesia recovery period in obese patients |
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| DOI： |
| 中文关键词: 头高位 肥胖 全麻苏醒期 呼吸 |
| 英文关键词: Head up tilt position Obesity Anesthesia recovery period Respiratory |
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| 中文摘要: |
目的：观察头高15°倾斜位对肥胖患者全麻苏醒期呼吸功能的影响。
方法：选择择期全麻下行显微耳科手术的肥胖患者80例, 男39例, 女41例, 年龄18～60岁, ASA Ⅰ或Ⅱ级, BMI≥28 kg/m2。随机分为两组: 头高15°倾斜位组(H组)和平卧位对照组(C组)。常规诱导行气管插管, 术中麻醉维持采用靶控输注(TCI)丙泊酚2～4 μg/ml和瑞芬太尼5～6 μg/ml, 维持BIS 40～60, 术中不追加肌松药,术毕C组采用平卧位, H组采用头高15°倾斜位。记录患者从轻唤睁眼后到达到拔除气管导管标准所需的时间(X), 达PACU出室标准所需的时间(Y), 拔管后吸入新鲜空气时SpO2由100%降至92%的时间(Z)和吸入纯氧后SpO2由92%上升至100%的时间(W)。记录入室时、吸氧3 min后、术毕时、气管拔除前及出PACU时的PaO2、PaCO2和pH。
结果：H组X（14±7） min、Y（45±7） min、W（39±11） s均明显短于C组[（19±6） min，（57±10） min，（51±9） s], Z（335±58） s明显长于C组（245±75） s(P<0.05)。气管拔除前和出PACU前H组PaO2[（193.4±30.5） mm Hg，（82.2±3.4） mm Hg]明显高于C组[（169.1±29.4） mm Hg,(70.8±4.1) mm Hg](P<0.05), 其他各时点PaO2差异均无统计学意义。两组各时点PaCO2和pH差异无统计学意义。
结论：头高15°倾斜位可有效促进肥胖患者全麻苏醒期呼吸功能的恢复, 安全可行。 |
| 英文摘要: |
Objective: To observe the effect of 15° head up tilt position on quality of respiratory system during anesthesia recovery period in obese patients.
Methods: Eighty obese patients in ASA physical status Ⅰ or Ⅱ, aged 18-60 years, with BMI≥28 kg/m2, scheduled for elective otological surgery with microscopy, were randomly divided into 2 equal groups (n=40 each): the 15° head up tilt position group (group H) and the supine position group (group C).With traditional induction, anesthesia was maintained by TCI of propofol 2-4 μg/ml and remifentanil 5-6 μg/ml, not supplying muscle relaxant during operation. After operation, group H was in 15° head up tilt position, while group C in supine position.The time spans from recovery of spontaneous breathing to meeting the extubation standard (X) and to meeting the standard for discharging form PACU (Y) were recorded. After extubation, we also recorded the time for SpO2decreased from 100% to 92% with fresh air (Z) and for SpO2 increased from 92% to 100% with pure oxygen (W). PaO2, PaCO2and pH were monitored before oxygen inhalation, after 3 min of oxygen inhalation, at the end of surgery, before extubation and before discharging from PACU.
Results: Compared with group C [(19±6) min, (57±10) min, (51±9) s], the time of X (14±7) min, Y (45±7) min and W (39±11) s, was significantly shorter and the time of W was obviously longer in group H (P<0.05). Compared with group C [(169.1±29.4) mm Hg, (70.8±4.1) mm Hg], the PaO2was increased obviously before extubation and discharging from PACU in group H [(193.4±30.5) mm Hg, (82.2±3.4) mm Hg](P<0.05). There was no significantly difference in PaO2 at other time points. There was no significantly difference in PaCO2and pH at all points.
Conclusion: 15° head up tilt position during anesthesia recovery period in obese patients can effectively improve the quality of respiratory system. |
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