运用空气泵以改善眼科局麻手术患者术中局部空气质量的临床观察

Clinical observation of patients using air pump to improve air-quality during eye surgery under local anaesthesia

目的探讨解决眼科局麻手术患者因手术铺巾遮盖口鼻,致憋闷、躁动等不适影响显微手术进行的方法。方法98例患者按随机数字表法分为对照组(鼻导管吸氧)49例和干预组(鼻导管吸氧+空气泵通气)49例,所有患者用麻醉监护仪监测血压,脉搏,脉搏氧饱和度,呼末二氧化碳分压,吸人气二氧化碳分压,呼吸频率,并运用数字分级评分法对患者舒适度进行评分。结果两组铺巾前吸人气二氧化碳分压为0mmHg,对照组吸人气二氧化碳分压从铺巾后3min的(6.27+1.79)mmHg持续升高至30 min的(17.00+2.00)mmHg;干预组吸人气二氧化碳分压从铺巾后3 min的(2.94+1.07)mmHg至30 min的(5.15+1.52)mmHg。对照组术中患者憋闷明显舒适度评分(3.94+0.59),干预组评分(0.46+0.38);两组组间患者铺巾后各时间点吸人气二氧化碳分压值和最终舒适度评分比较差异有统计学意义(P<0.01),对照组内铺巾3 min后不同时间点的吸人气二氧化碳分压值比较差异有统计学意义(P<0.01),在30 min的观察期内持续升高;干预组内3 min后各时间点的吸人气二氧化碳分压值统计无差异(P>0.05),波动幅度小,且5 min后基本保持平稳。两组脉搏和氧饱和度术前与术中无明显变化。结论铺巾后局部二氧化碳储留持续加重,空气泵的使用可以明显改善眼科局麻手术患者术中局部空气质量,干预简单有效且效果稳定,明显减少了患者二氧化碳重复吸入,提高了患者舒适度。

Objective To observe the effect of using air pump to improve air-quality in patients during eye surgery under local anesthesia,the change of the concentration of carbon dioxide under the surgical drapes,and the change of the comfort scores compare with that without air pump.Methods In both the control group(oxygen inhalation through nasal catheter,49 cases)and intervention group(oxygen inhalation through nasal catheter combined with air pump,49 cases),the blood pressure,pulse,oxygen saturation,end-tidal carbon dioxide partial pressure,the partial pressure of inhale carbon dioxide,and the breathing rate were measured at different times during the surgeries.And the patient's comnfort rates were scored with the Digital Classification Evaluation at the end of the surgeries.Results The partial pressure of inhale carbon dioxide was 0.00 mmHg before being covered by surgical drapes in both groups.In the control group,the partial pressure of inhale carbon dioxide persistently increased from(6.27+1.79)mmHg 3 minutes after covered by surgical drapes to(17.00+2.00)mmHg at 30 minutes.The partial pressure of inhale carbon dioxide of the intervention group increased from(2.94+1.07)mmHg at 3 minutes to(5.15+1.52)mmHg at 30 minutes,which ceased increasing after 20 minutes.Some patients in the control group felt oppressed obviously,and gave the comfort score(3.94+0.59)while the intervention group gave(0.46+0.38).After a comparison analysis of the partial pressure of inhale carbon dioxide between and within either group at each time point,and the comfort scores between the two groups of patients,the statistical analysis of SPSS(17.0)gave results of signifcant difference(P<0.01).No significant changes were observed in pulse rate and oxygen saturation for the two groups in preoperative and intraoperative periods.Conclusions After using the drapes,local carbon dioxide retention increased persistently,and air pump could continually improve local air--quality of the patients undergoing local anesthesia during ophthalmic surgery.The procedure of the intervention is simple,effective and stable,and the patient's comfort scores are improved obviously.