慢性贫血因素对女性患者全麻诱导气管插管时无通气安全时限的影响

Effect of chronic anemia on duration of non-hypoxic apnea during tracheal intubation after induction of general anesthesia in female patients

目的 评价慢性贫血因素对女性患者全麻诱导气管插管时无通气安全时限的影响.方法 择期妇科手术患者,年龄20 ～ 40岁,ASA分级Ⅰ或Ⅱ级,Mallampati分级Ⅰ或Ⅱ级,BMI＜ 25kg/m2.根据术前血红蛋白（Hb）分为3组（n=25）：Hb＞ 110 g/L组（A组）、Hb 90～110 g/L组（B组）、70g/L＜ Hb＜ 90 g/L组（C组）.面罩吸入纯氧8 L/min,3 min后常规全麻诱导,诱导期间不进行辅助通气;气管插管后待SpO2降至90％时行纯氧人工通气.记录患者呼吸停止至SpO2降至90％的时间（无通气安全时限）、观察期内最低SpO2和最高PETCO2;分别于面罩吸氧前即刻、呼吸停止即刻及SpO2降至90％时每组随机选10例患者采集桡动脉血行血气分析.结果 与A组相比,B组和C组无通气安全时限缩短（P＜0.01）,最低SpO2差异无统计学意义（P＞0.05）,C组最高PET CO2、SpO2降至90％时PaCO2降低（P＜0.01）;与B组相比,C组无通气安全时限缩短,SpO2降至90％时PaCO2降低（P＜0.01）,最低SpO2和最高PET CO2差异无统计学意义（P＞0.05）.结论 轻度、中度慢性贫血可将女性患者全麻诱导气管插管时无通气安全时限分别缩短至约6.0、3.5 min.

Objective To evaluate the effect of chronic anemia on duration of non-hypoxic apnea during tracheal intubation after induction of general anesthesia in female patients.Methods Seventy-five ASA physical status Ⅰ or Ⅱ patients,aged 20-40 yr,of Mallampati class Ⅰ or Ⅱ,with body mass index 〈 25 kg/m2,were enrolled in the study.According to the test results of hemoglobin （Hb）,the patients were allocated into 3 groups （n =25 each）：Hb 〉 110 g/L group （group A）,Hb 90-110 g/L group （group B）,and 70 g/L 〈 Hb 〈 90 g/L group （group C）.Each patient inhaled 100% oxygen through a mask with oxygen flow of 8 L/min and 3 min later anesthesia was induced with general anesthesia.Assisted ventilation was not performed during induction.After tracheal intubation,artificial ventilation was performed with pure oxygen when SpO2 decreased to 90%.The time from beginning of apnea to SpO2 of 90% （duration of non-hypoxic apnea）,and the minimum SpO2 and the maximum PET CO2 during the period of observation were recorded.Immediately before oxygen inhalation via a mask,immediately after beginning of apnea,and at the time for SpO2 decreasing to 90%,arterial blood samples were taken from 10 patients randomly chosen from each group for blood gas analysis.Results Compared with group A,the duration of non-hypoxic apnea was significantly shortened,and no significant change was found in the minimum SpO2 in B and C groups,and the maximum PET CO2 and PaCO2 while SpO2 decreasing to 90% were decreased in group C.Compared with group B,the duration of non-hypoxic apnea was signifi.cantly shortened,PaCO2 while SpO2 decreasing to 90% was decreased,and no significant change was found in the minimum SpO2 and the maximum PET CO2 in group C.Conclusion Mild and moderate chronic anemia shortens the duration of non-hypoxic apnoea to about 6.0 and 3.5 min,respectively,during tracheal intubation after induction of general anesthesia in female patients.