脊柱手术中体位变化对全麻高浓度氧通气效果影响.docVIP

脊柱手术中体位变化对全麻高浓度氧通气效果影响 　　[摘要] 目的 分析脊柱手术过程中体位变化影响全麻高浓度氧通气的效果。方法 选择腰椎后路手术的82例ASA I～II级患者均接受全麻，在以100%氧浓度麻醉诱导后以80%氧浓度行机械通气时间15 min（Ta）、体位从仰卧位变成俯卧位时间15 min（Tb）、俯卧位后1 h（Tc）、俯卧位变成仰卧位前（Td）、翻身变成仰卧位后15 min（Te）分别监测，然后算出肺泡动脉氧含量差、氧合指数。 结果 Tb～Te各时间点的肺泡气与动脉血氧分压差明显小于Ta时间点，差异有统计学意义（P0.05）。患者处于俯卧位状态下（Tb-Td）时间点时，平均气道压与仰卧位（Ta、Te）比较明显增高，但顺应性明显下降，差异有统计学意义（P0.05）。 结论 在正确体位状态下行脊柱手术期间，俯卧位能提高患者氧合效果。 　　[关键词] 脊柱手术；体位变化；全麻高浓度氧通气 　　[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2014）22-0048-02 　　[Abstract] Objective To study the impacts of position changes on high concentration oxygen ventilation in spinal surgery under general anesthesia. Methods A total of 82 ASA I-II patients for lumbar posterior surgery under general anesthesia were enrolled for study. At the time points of 15 mins after anesthesia induction（Ta），15 mins after position change from supine to prone（Tb），1 hour after the prone position（Tc），at the end of prone position（Td） and 15 mins after the supine position（Te） arterial blood gas，at the same time，alveolar artery oxygen content and oxygenation indexs were calculated. Results From time point of Tb to Te，alveolar air and arterial blood oxygen partial pressure difference were much smaller than that of Ta， the differences were statistically significant. Mean airway pressure were significantly increased while the pulmonary compliance decreased obviously at the time points of Ta and Te when compared with those at time points of Tb，Tc and Td. Conclusion Under high concentration oxygen ventilation，prone position during spinal surgery can not only increase airway pressure，but also reduce pulmonary compliance and improve patients ventilation and oxygenation. 　　[Key words] Spinal surgery；Position change；High concentration oxygen ventilation general anesthesia 　　麻醉手术期间常规吸氧使患者体内氧分压升高，但会增加患者在麻醉诱导插管、灌注、低血压等环节中对缺氧症状的耐受时间[1]，还会缓解患者心血管功能，所以，诸多全身麻醉手术时，患者常规吸入高浓度氧气。但部分患者在全身麻醉诱导下，或是麻醉维持期间出现不同程度的肺不张现象，进而使肺内血管分流有所升高，氧合效率有所降低，其关键原因在于吸入高浓度氧。本研究针对脊柱手术过程中患者不同体位时血气参数、呼吸参数的变化，进一步分析脊柱手术过程中俯卧体位变化对其机械吸入高浓度氧的氧合效