全麻苏醒期代谢改变

Metabolic changes during recovery period of general anesthesia

目的 探讨麻醉苏醒期的代谢改变。方法 2 0例颅脑和胸腹部手术的全麻病人在分别于诱导前、插管后 1 5分钟、切皮时、拔管前即刻和拔管后 1 5分钟测定呼吸频率 (RR)、潮气量(VT)、吸入气氧分数 (FIO2 )、呼出气氧分数 (FEO2 )、吸入气CO2 分数 (FICO2 )和呼出气CO2 分数(FECO2 ) ,同时测定血压、心率和SpO2 。结果 大部分病人在苏醒过程中有躁动、挣扎、不耐受导管和痛苦等表现。在拔管前即刻心率、收缩压乘积显著增加 (1 968 44± 31 0 33) ,拔管后 1 5分仍高于基础水平。拔管前即刻RR和MV明显增加。拔管前即刻 VO2 和 VCO2 均显著增加 ,同时产热量也增加。拔管后 1 5分钟这三种参数仍未恢复至基础值。结论 苏醒期存在明显应激反应和代谢改变 ,因素是多方面的 。

Objective To investigate the metabolic changes of the patients during recovery period from general anesthesia.Methods Twenty patients scheduled for elective intracranial,thoracic,or abdominal surgeries under general anesthesia were studied.The respiratory rate(RR),tidal volume(V T),minute ventilation volume(MV),inspired(F IO 2) and expired(F EO 2) oxygen fraction,end tidal(F ECO 2) and inspired(F ICO 2) carbon dioxide tension,arterial blood pressure(BP),heart rate(HR) and pulse O 2 saturation(SpO 2) were measured before induction,at 15min after intubation,immediate before and 15min after extubation.Oxygen consumption(O 2) and carbon dioxide output(CO 2) were calculated with Ficks method.Results Most of the patients were not tolerated to tracheal intubation,struggling manifected by experienced restlessness during recovery.The product of heart rate and systotic arterial blood pressure,O 2,CO 2 and the value of heat production were increased significantly duration recovery( P< 0 05).Conclusion There are hypermetabolic responses to tracheal tubing,suctioning,coughing and pain during recovery period from general anesthesia,which should be prevented and attenuated effectively. [