Lehmann K A, Asoklis S, Grond S, Schroeder B
Institut für Anaesthesiologie und Operative Intensivmedizin, Universität zu Köln.
Anaesthesist. 1993 Apr;42(4):227-31.
In an attempt to verify non-invasive respiratory monitoring for patients in the early postoperative period, cutaneous O2 and CO2 pressures were monitored in 30 female patients recovering from major gynaecologic surgery under halothane anaesthesia. In a double-blind and randomized fashion, in the recovery room the patients received a single intravenous bolus injection of placebo or 150 mg amiphenazole, a respiratory stimulant. The data were collected and stored in a personal computer, using the TCM3 system with a combination electrode for simultaneous measuring of cutaneous oxygen and carbon dioxide partial pressures (TINA, Radiometer) at 30-s intervals. The overall observation period was 240 min. Means and standard deviations were calculated for individual data and for data pooled at 15- or 60-min intervals. Groups were compared by means of the chi 2 test, Student's t-test, Wilcoxon rank sum test or analysis of variance (level of significance P < or = 0.05).
The study groups were comparable with respect to demographic and anaesthesiological data. The partial pressures for both O2 and CO2 were not statistically significant between groups. Electrode heating was slightly higher with amiphenazole (n.s.), indicating a trend for peripheral vasodilation without a true improvement of spontaneous ventilation. pctO2 and pctCO2 levels were decreased or elevated, respectively, in the first observation hours and slowly returned to normal within the 240-min observation period. Episodes of hypercapnia (pct-CO2 > 50 or > 55 mm Hg) were frequent in the first 2 h (10-30% of individual data for pctCO2 > 50, 2-7% for pctCO2 > 55, respectively), indicating the need for close monitoring of spontaneous respiration after general anaesthesia with halothane.
The present study confirmed that spontaneous respiration in the early postoperative period can be monitored non-invasively by measuring transcutaneous partial pressures of carbon dioxide and, less precisely due to large individual variations, oxygen. It showed that spontaneous respiration deteriorates after gynaecological surgery under halothane anaesthesia and recovers slowly during the next 4 h. The respiratory stimulant amiphenazole (150 mg i.v.) was of no significant value with respect to the improvement of ventilation.
为验证术后早期患者的无创呼吸监测，对30例接受氟烷麻醉下大型妇科手术的女性患者进行皮肤氧分压和二氧化碳分压监测。在恢复室，患者以双盲随机方式接受安慰剂或150mg阿米苯唑（一种呼吸兴奋剂）单次静脉推注。使用带有复合电极的TCM3系统，以30秒间隔同时测量皮肤氧分压和二氧化碳分压（TINA，Radiometer），数据收集并存储于个人电脑。总观察期为240分钟。计算个体数据以及15分钟或60分钟间隔汇总数据的均值和标准差。采用卡方检验、学生t检验、威尔科克森秩和检验或方差分析比较组间差异（显著性水平P≤0.05）。
研究组在人口统计学和麻醉学数据方面具有可比性。两组间氧分压和二氧化碳分压均无统计学显著差异。阿米苯唑组电极加热略高（无统计学意义），表明有外周血管扩张趋势，但自主通气未真正改善。在最初观察小时内，pctO2和pctCO2水平分别降低或升高，并在240分钟观察期内缓慢恢复正常。高碳酸血症发作（pct - CO2＞50或＞55mmHg）在最初2小时频繁出现（pctCO2＞50时个体数据的10 - 30%，pctCO2＞55时为2 - 7%），提示氟烷全身麻醉后需密切监测自主呼吸。
本研究证实，术后早期可通过测量经皮二氧化碳分压无创监测自主呼吸，而由于个体差异较大，测量经皮氧分压监测自主呼吸不太精确。结果显示，氟烷麻醉下妇科手术后自主呼吸恶化，并在接下来4小时内缓慢恢复。呼吸兴奋剂阿米苯唑（150mg静脉注射）对改善通气无显著价值。
