预给氧：最大呼吸与潮气量呼吸技术的比较

Preoxygenation: comparison of maximal breathing and tidal volume breathing techniques.

作者信息

Baraka A S, Taha S K, Aouad M T, El-Khatib M F, Kawkabani N I

机构信息

Department of Anesthesiology, American University of Beirut, Lebanon.

出版信息

Anesthesiology. 1999 Sep;91(3):612-6. doi: 10.1097/00000542-199909000-00009.

DOI:10.1097/00000542-199909000-00009

PMID:10485768

Abstract

BACKGROUND

Preoxygenation with tidal volume breathing for 3-5 min is recommended by Hamilton and Eastwood. This report compares tidal volume preoxygenation technique with deep breathing techniques for 30-60 s.

METHODS

The study was conducted in two parts on patients undergoing elective coronary bypass grafting. In the first group (n = 32), each patient underwent all of the following preoxygenation techniques: the traditional technique consisting of 3 min of tidal volume breathing at an oxygen flow of 5 l/min; four deep breaths within 30 s at oxygen flows of 5 l/min, 10 l/min, and 20 l/min; and eight deep breaths within 60 s at an oxygen flow of 10 l/min. The mean arterial oxygen tensions after each technique were measured and compared. In the second group (n = 24), patients underwent one of the following techniques of preoxygenation: the traditional technique (n = 8), four deep breaths (n = 8), and eight deep breaths (n = 8). Apnea was then induced, and the mean times of hemoglobin desaturation from 100 to 99, 98, 97, 96, and 95% were determined.

RESULTS

In the first group of patients, the mean arterial oxygen tension following the tidal breathing technique was 392+/-72 mm Hg. This was significantly higher (P<0.05) than the values obtained following the four deep breath technique at oxygen flows of 5 l/min (256+/-73 mm Hg), 10 l/min (286+/-69 mm Hg), and 20 l/min (316+/-67 mm Hg). In contrast, the technique of eight deep breaths resulted in a mean arterial oxygen tension of 369+/-69 mm Hg, which was not significantly different from the value achieved by the traditional technique. In the second group of patients, apnea following different techniques of preoxygenation was associated with a slower hemoglobin desaturation in the eight-deep-breaths technique as compared with both the traditional and the four-deep-breaths techniques.

CONCLUSION

Rapid preoxygenation with the eight deep breaths within 60 s can be used as an alternative to the traditional 3-min technique.

摘要

背景

汉密尔顿和伊斯特伍德建议采用潮气量呼吸进行3 - 5分钟的预充氧。本报告比较了潮气量预充氧技术与深呼吸技术（持续30 - 60秒）。

方法

该研究分两部分对接受择期冠状动脉搭桥手术的患者进行。在第一组（n = 32）中，每位患者均接受以下所有预充氧技术：传统技术，即5升/分钟氧气流量下3分钟的潮气量呼吸；在5升/分钟、10升/分钟和20升/分钟氧气流量下30秒内进行4次深呼吸；以及在10升/分钟氧气流量下60秒内进行8次深呼吸。测量并比较每种技术后的平均动脉血氧张力。在第二组（n = 24）中，患者接受以下预充氧技术之一：传统技术（n = 8）、4次深呼吸（n = 8）和8次深呼吸（n = 8）。然后诱导呼吸暂停，并确定血红蛋白饱和度从100%降至99%、98%、97%、96%和95%的平均时间。

结果

在第一组患者中，潮气量呼吸技术后的平均动脉血氧张力为392±72毫米汞柱。这显著高于（P<0.05）在5升/分钟（256±73毫米汞柱）、10升/分钟（286±69毫米汞柱）和20升/分钟（316±67毫米汞柱）氧气流量下进行4次深呼吸技术所获得的值。相比之下，8次深呼吸技术导致的平均动脉血氧张力为369±69毫米汞柱，与传统技术所达到的值无显著差异。在第二组患者中，与传统技术和4次深呼吸技术相比，不同预充氧技术后的呼吸暂停在8次深呼吸技术中血红蛋白饱和度下降较慢。