佩戴口罩对保留自主呼吸机体接受麻醉面罩吸氧时血液氧合状态影响的探讨

Effects of wearing a mask on oxygenation of subjects with spontaneous breathing during supplementary oxygen through facemask

在COVID-19播散期间,手术患者在手术间内佩戴口罩是疫情防控管理措施之一。麻醉医生通常会为非全麻手术患者提供吸氧,其中经麻醉面罩吸氧是常见方式,然而佩戴口罩对保留自主呼吸的机体接受麻醉面罩下吸氧的血液氧合状态的影响目前尚无任何相关研究数据。本研究以健康志愿者作为研究对象,采用自身前后对照试验,在受试者佩戴或不戴一次性医用口罩两种情形下测定了经麻醉面罩下吸氧前后相应时间点的血液氧合状态的变化趋势。与吸氧前基础值相比,10例健康受试者无论是否佩戴一次性医用口罩,均可有效增加受试者氧供;但与不戴口罩组相比,戴口罩组各时间点的动脉血氧分压均明显降低,差异具有统计学意义。两组其他呼吸氧合参数无明显差异。同时数据提示年龄增长与吸烟对戴口罩组和不戴口罩组之间的动脉血氧分压差值没有明显影响。本文首次验证了机体在佩戴一次性医用口罩再接受麻醉面罩吸氧时可以有效增加机体氧供,脉搏氧饱和度和动脉血氧饱和度均能迅速达到100%,为要求播散性呼吸道疾病患者进入手术室佩戴口罩的管理措施提供了理论依据;但与直接麻醉面罩吸氧方式相比,其动脉血氧分压上升速度和幅度都有明显降低。这种差异对临床结局是否会带来影响,尚需进一步研究。

During the COVID-19 epidemic,our national guidelines have suggested that surgical patients should wear a mask to decrease the potential transmission of COVID-19 in the operating room,as long as the condition allows.However,so far,there is no study to discuss the influence of wearing a mask on the ventilation and blood oxygenation status in patients of spontaneous breathing with supplementary oxygen through an anesthetic facemask.This is a beforeafter study in the same patient,and 10 healthy volunteers were recruited,by testing the arterial blood gas parameters at key time points before and after oxygen inhalation to evaluate the effects of two different supplementary oxygen methods(‘disposable medical mask+anesthetic facemask’and‘anesthetic facemask only’)on the oxygenation of subjects.Our data demonstrated whether wearing a disposable medical mask or not could effectively increase the oxygen supply of the subjects compared with the basic value before oxygen inhalation;however,compared with the group without mask,the arterial oxygen partial(PaO2)reduced significantly at each time points when subjects wearing a disposable medical mask.There was no significant difference in other parameters,and our data showed that age growth and smoking had no significant effects on the difference of PaO2 between the groups with and without masks.This study demonstrates effective oxygen supplementation through anesthetic facemask in subjects with spontaneous breathing who is wearing a disposable medical mask,whose pulse oxygen saturation and arterial oxygen saturation can reach 100%rapidly,and this provides a theoretical basis for the management of patients with disseminated respiratory diseases to wear masks in the operating room;however,the rate and amount of PaO2 increase are both decreased as compared to those who is not wearing a disposable medical mask during supplementary oxygenation.Whether this difference will affect the clinical outcome needs further study.