预充氧对减少吸痰导致组织缺氧的临床观察

Effect of Preoxygenation on Tracheal Suction Induced Tissue Hypoxia in Critically Ill Patients

为研究预充氧对吸痰导致组织缺氧的影响，在非预充氧和预充氧条件下，观察１４ 例危重患者吸痰前、吸痰结束时、吸痰后５ 分钟动脉血气和混合静脉血气的变化。结果：与吸痰前相比，非预充氧组吸痰结束时的动脉血氧分压（ＰａＯ２） 、动脉血氧饱和度（ＳａＯ２）、混合静脉血氧分压（ＰｖＯ２）、混合静脉血氧饱和度（ＳｖＯ２） 均显著降低（ Ｐ＜０．０５），吸痰结束后５ 分钟，ＳｖＯ２ 仍未恢复正常。如给予预充氧，吸痰结束时无低氧血症，组织缺氧较轻，虽然ＰａＯ２ 、ＳａＯ２ 、ＰｖＯ２ 、ＳｖＯ２ 亦低于吸痰前水平，但明显高于非预充氧组吸痰结束时的水平。吸痰结束后５ 分钟，组织缺氧完全纠正。结论：预充氧可以预防吸痰导致的低氧血症和组织缺氧。

To evaluate the effect of preoxygenation on tracheal suction induced tissue hypoxia in critically ill pationts,14 critically ill patients with artificial airway and mechanical ventilation were studied. Arterial and mixed venous blood gas were compared at pre suction, after and 5 minutes after tracheal suction between non preoxygenatoin and oxygenation groups. Results: As compared with pre suction, PaO 2, SaO 2, PvO 2 and SvO 2 decreased markedly after suction in non preoxygenation group. At 5 minutes after suction, hypoxemia was improved, but PvO 2 and SvO 2 remained at low levels. Compared with pre suction, PaO 2, SaO 2, PvO 2and SvO 2 decreased markedly after suction in preoxygenation group, but there was no arterial hypoxemia. Compared with non preoxygenation group, PvO 2 and SvO 2 were higher significantly after suction. At 5 minutes after suction, PaO 2, SaO 2, PvO 2 and SvO 2 returned to normal. Conclusion: Preoxygenation may prevent arterial hypoxemia and tissue hypoxia induced by tracheal suction. Author's address Department of Intensive Unit, Nanjing Railway Medical College Hospital, Nanjing 210009