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[成年患者插管后呼吸暂停期间动脉血氧饱和度的持续监测]

[Continuous monitoring, in the adult, of arterial oxygen saturation during apnea following intubation].

作者信息

Arnaud D, Granthil C, Duflot J C, François G

机构信息

Département d'Anesthésie-Réanimation, CHU Timone, Marseille.

出版信息

Ann Fr Anesth Reanim. 1988;7(1):8-12. doi: 10.1016/s0750-7658(88)80004-2.

Abstract

Twenty ASA I or II patients were studied to assess the safety of oxygenation for 4 min prior to intubing, so as to prevent the hypoxaemia related to tracheal intubation. The arterialized capillary blood saturation (Spo2) was continuously monitored with a pulse oximeter Nellcor 100 equipped with a finger probe. Patients spontaneously breathed oxygen (FIO2 = 1) while anaesthesia was induced with pancuronium bromide, thiopentone and fentanyl. Following apnoea, ventilation was manually controlled during 4 min (FIO2 = 1). The values of Spo2 were recorded before induction, at the end of the 4 min oxygenation period and after 5 min of apnoea. An arterial blood sample was withdrawn at the end of apnoea and analysed immediately using an OSM 2b hemoximeter. Apnoea was interrupted in case of desaturation below 95%, new arrhythmia or haemodynamic instability (blood pressure +/- 20% of control value). Mean saturation (+/- SD) before oxygenation was 98.6 +/- 1.35%. After oxygenating for 4 min, all the Spo2 reached 100%. After the 5 min apnoea period, no saturation was below 95% (mean +/- SD = 98.89 +/- 1.66); at this time, Sao2 and Spo2 did not significantly differ (p less than 0.001). In one case, apnoea had to be interrupted, because of the occurrence of arrhythmias, unrelated to a blood gas disorder (PaO2 = 225 mmHg; Paco2 = 34 mmHg; SaO2 = 100%; pH = 7.44). This study confirmed the efficacy and safety of oxygenating for 4 min before intubation.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

对20例美国麻醉医师协会(ASA)分级为I或II级的患者进行研究,以评估插管前4分钟给氧的安全性,从而预防与气管插管相关的低氧血症。使用配备手指探头的Nellcor 100脉搏血氧仪持续监测动脉化毛细血管血氧饱和度(Spo2)。在使用溴化潘库溴铵、硫喷妥钠和芬太尼诱导麻醉时,患者自主呼吸氧气(吸入氧分数=FIO2 = 1)。呼吸暂停后,在4分钟内手动控制通气(FIO2 = 1)。记录诱导前、4分钟给氧期结束时和呼吸暂停5分钟后的Spo2值。呼吸暂停结束时抽取动脉血样本,立即使用OSM 2b血氧计进行分析。如果饱和度低于95%、出现新的心律失常或血流动力学不稳定(血压±对照值的20%),则中断呼吸暂停。给氧前的平均饱和度(±标准差)为98.6±1.35%。给氧4分钟后,所有Spo2均达到100%。在5分钟呼吸暂停期后,没有饱和度低于95%(平均±标准差=98.89±1.66);此时,动脉血氧饱和度(Sao2)和Spo2无显著差异(p<0.001)。在1例患者中,由于出现与血气紊乱无关的心律失常(动脉血氧分压=225 mmHg;动脉血二氧化碳分压=34 mmHg;动脉血氧饱和度=100%;pH = 7.44),不得不中断呼吸暂停。本研究证实了插管前4分钟给氧的有效性和安全性。(摘要截短至250字)

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