全麻诱导期不同面罩通气压力水平对患者氧饱和度、胃胀气程度及恶心、呕吐的影响

Effects of different mask ventilation pressure during general anesthesia induction on patients′oxygen saturation,flatulence,nausea and vomiting

目的:分析全麻诱导期不同面罩通气压力水平对患者氧饱和度(SpO_(2))、胃胀气程度及恶心、呕吐反应的影响。方法:将2017年1月~2019年12月于新疆军区总医院行妇科腹腔镜手术的90例患者纳入研究,采用随机数字表法将其随机分为P12、P15及P20组,每组30例,在全麻诱导期予患者不同水平的面罩通气压力,比较3组患者相关临床资料,根据患者术后48 h内是否出现恶心、呕吐反应分为反应组及无反应组,比较并分析面罩通气压力水平与胃胀气程度的相关性。结果:P20组患者插管后SpO_(2)水平高于P15及P12组患者,术后出现恶心、呕吐反应的人数多于P12组患者,且P20组和P15组患者胃胀气程度均高于P12组患者(P<0.05);反应组患者面罩通气压力、插管后SpO_(2)水平及胃胀气程度均高于无反应组(P<0.05);Logistic分析示面罩通气压力水平升高(OR=1.469,95%CI:1.186~1.819)是术后出现恶心、呕吐反应的危险因素(P<0.05),且面罩通气压力水平与胃胀气程度呈正相关(r=0.676,P<0.01)。结论:全麻诱导期,20 cm H_(2)O面罩通气压力水平可有效提高患者的SpO_(2),但同时胃胀气程度及术后发生恶心、呕吐反应风险也会升高。

Objective:To observe the effects of different mask ventilation pressure on oxygen saturation(SpO_(2)),gastric distention level,nausea and vomiting in patients during general anesthesia induction.Methods:Ninety patients undergoing gynecological laparoscopic surgery in our hospital were included from January 2017 to December 2019,and randomly divided into group of P12(12 cm H_(2)O),P15(15 cm H_(2)O)and P20(20 cm H_(2)O)by random number table(n=30 in each group).Diverse level of mask ventilation pressure was applied to the patients during anesthesia induction period,and relevant clinical data were compared among the three groups.Then the patients were sub-grouped into reaction group and non-response group according to presence or absence of nausea and vomiting within 48 hours after surgery to analyze the correlation of different mask ventilation pressure with the degree of flatulence.Results:Patients in P20 group had significantly higher SpO_(2)level following intubation than those in P15 and P12 groups,and higher incidence of nausea and vomiting after operation than those in P12 group,and the degree of flatulence in the P20 and P15 groups was significantly higher than that of the P12 group(all P<0.05).The mask ventilation pressure,SpO_(2)level after intubation and the degree of flatulence were obviously higher in the reaction group than in the non-response group(P<0.05).Logistic analysis showed that increased mask ventilation pressure(OR=1.469,95%CI:1.186-1.819)was a risk factor for postoperative nausea and vomiting(P<0.05),and the mask ventilation pressure was positively correlated with the degree of flatulence(r=0.676,P<0.01).Conclusion:Mask ventilation pressure set at 20 cm H_(2)O during the induction period of general anesthesia can effectively improve the patient′s SpO_(2),whereas increase the degree of flatulence and incidences of postoperative nausea and vomiting.