麻醉前快速预氧在无痛人工流产手术中的应用

THE APPLICATION OF RAPID PREOXYGENATION TECHNIQUE FOR PAINLESS INDUCED ABORTION IN OUTPATIENT

目的观察麻醉前快速预氧对无痛人流手术中呼吸抑制导致的缺氧的预防作用。方法 100例人流患者,随机分为二组,每组50例,快速预氧组患者在麻醉前做8次深呼吸,对照组保持自然呼吸,麻醉方法均为咪唑安定1mg,舒芬太尼0.1μg/kg,丙泊酚2mg/kg,术中间断推注丙泊酚0.5mg/kg。观察麻醉时间、手术时间、失血量、异丙酚总量、术中呼吸抑制和呼吸暂停发生率及PetCO2和SpO2变化情况。结果二组的一般情况,麻醉时间、手术时间、失血量、丙泊酚用量和基础PetCO2之间差异均无统计学意义(P>0.05)。对照组和预氧组间呼吸抑制的发生率分别为18例(36%)和17例(34%),呼吸暂停的发生率分别为8例(16%)和10例(20%),差异无统计学意义(P>0.05);对照组和预氧组中最高PetCO2值分别为(48.33±3.48)cmH2O和(42.65±4.13)cmH2O(P<0.05),而对照组SpO2值低于95%者为15例(30%),明显高于预氧组0例(0%)(P<0.05)。结论麻醉前预吸氧能增加机体氧储备,提高对缺氧的耐受性,减少CO2蓄积,可有效避免无痛人流手术中呼吸抑制所致的缺氧和CO2蓄积。

Objective To investigate the preventive effects of rapid preoxygenation technique to hypoxia caused by respiratory depression during painless induced abortion in outpatient. Methods One hundred ASA Ⅰ -Ⅱ patients undergoing outpatient painless induced abortion were randomly allocated into two groups. Group C patients received tidal volume breathing and group P patients received eight deep breaths （DB） in 1 min before anesthesia. All patients were induced with midazolam 1 mg, sufentanil 0. lug/kg and Propofol 2mg/kg, and were maintained with Propofol 0. 5mg/kg when needed. The following were ob- served and recorded The incidence of respiratory depression and apnea, the time of anesthesia, the time of operation, blood loss, the total doses of Propofol and the change in PetCO2 and SpO2. Results There was no significant difference in demographic characteristics, the time of anesthesia, the time of operation, blood loss, the total doses of Propofol and baseline PetCO2 between groups （P〉0.05）. There was no significant difference in the incidence of respiratory depression [18（36%） vs. 17（84%）] and apnea [8（16%） vs. 10 （20%）] between group C and group P （P〉0.05）. However, there was significant difference in the peak of PetCO2148.33 ± 3.48cmH20 vs. 42.65 ± 4.13 cmH2O] between group C and group P （P〈0. 05）. And the incidence of hypoxia in group C [15（30%）] was significantly higher than that in group P [0（0%）]（P〈0.05）. Conclusion Rapid preoxygenation technique can increase the oxygen reserve and improve the tolerance to hypoxia. At the same time, rapid preoxygenation technique can also decrease the accumulation of carbon dioxide. It is effectual to avoiding hypoxia and hypercapnia caused by respiratory depression and apnea during painless induced abortion in outpatient.