不同氧合指标用于全麻期间氧代谢监测的评价

EVALUATION OF MONITOR FOR OXYGEN METOBOLISM DURING GENERAL ANESTHESIA BY OXYGENATION INDEXES

目的 :分析不同氧合指标在全麻期间氧代谢监测中的变化情况 ,并评价这些指标在氧代谢监测中的意义和局限性 ,为术中氧代谢监测提供合理的指标。方法 :选择上腹部手术全麻病人 (年龄 2 5～ 78岁 ) 30例 ,ASA ～ 级 ,按数字随机法分为老年组 (年龄 >6 5岁 ,n =15 )和青壮年组 (年龄 <6 5岁 ,n =15 ) ,监测麻醉期间病人脉搏血氧饱和度 (Sp O2 )、氧供量(DO2 )、氧耗量 (VO2 )、氧摄取率 (ERO2 )、混合静脉血氧饱和度 (SVO2 )和动脉血乳酸含量 (ABL)等指标动态变化的情况。结果 :Sp O2 在整个麻醉期间无明显变化 (P >0 .0 5 ) ,与麻醉前比较 ,老年病人麻醉诱导后至术毕 30 m in,DO、 VO、ERO均下降 ,SVO及 ABL 均升高 ,这种趋势呈现一定的时效性 ,在统计学上有显著或非常显著的意义 (P <0 .0 5或 P <0 .0 1)。而青壮年病人各氧合指标呈现相似的变化 ,但变化幅度略小 ,并且 ABL无明显变化。结论 :Sp O2 不是反映全身氧代谢情况的可靠指标 ,尤其在麻醉生理和病理状态下更为明显。要全面反映全麻期间上腹部手术病人全身氧代谢情况 ,必须结合 DO2 、 VO2 、 ERO2 、 SVO2 及 ABL等氧合指标综合分析。

Objective:To analysize the changes of several oxygenation indexes for oxygen metobolism during general anesthesia,and evaluate their applied specificity and give some reasonable ways to monitor oxygen metobolism Methods:Thirty patients,ASA class Ⅰ or Ⅱ,undergoing major abdominal surgery with general anesthesia,were randomly allocated to two groups,one was more than 65 years (n=15),another less than 65 years (n=15) Within the two groups,the dynamic changes of pulse oxygen saturation(SpO 2),oxygen delivery (DO 2),oxygen consumption (VO 2),oxygen extraction rate (ERO 2),mixed venous oxygen saturation (SVO 2),and arteral blood lactate (ABL),were monitored during anesthesia Results:There were not any changes in SpO 2 for these two groups (P>0 05) From anesthesia induction to thirty minutes after operation,DO 2,VO 2,ERO 2 in geriatric general anesthesia group were decreased and SVO 2,ABL increased significantly compared with those before anesthesia (P<0 05,or P<0 01),and there was a same change for DO 2,VO 2,ERO 2,SVO 2 in the other group in the same stage as this in the geratric genaeral anesthesia group (P<0 05),but ABL did not change significantly (P>0 05) Conclusions:SpO 2 can not reflect the situation of systemic oxygen metobolism reliably,and it is very necessary to combine DO,VO 2,ERO 2,SVO 2 and ABL