麻醉手术期间小儿和成人呼吸氧价变化的临床研究

Changes of oxygen cost of breathing in children and adult during anesthesia and surgery

目的比较麻醉手术期间成人和小儿呼吸氧价的变化。方法成人和小儿颅内肿瘤手术患者各12例,分为成人组和小儿组。在快速麻醉诱导气管插管后行机械通气,分别在诱导前5 min、切皮前1 min和手术开始后30、60、120、180 min及术毕时等各时点记录血流动力学和呼吸功能的各项参数。结果在整个观察期间,两组病人血压的波动幅度不大(P>0.05),小儿组病人的心率均较成人快(P<0.01)。两组切皮前1 min、手术开始后30 min的氧耗(VO2)与诱导前(组内)有显著性差异(P<0.01);小儿组在切皮前1 min和手术开始后30 min时的VO2较成人组高(P<0.05);小儿组与成人组比较,在切皮前1 min、手术开始后30 min及术毕时的呼吸氧价有显著性差异(P<0.01),而在手术开始后60、120 min时的呼吸氧价也有显著性差异(P<0.05)。结论在麻醉手术期间,小儿组的VO2显著高于成年组,而小儿组的呼吸氧价却明显低于成年人。

Objective To investigate the changes of oxygen cost of breathing (OCB) in children and adult during general anesthesia and surgery. Methods This study included 12 elective surgical children and 12 adult patients receiving cerebral surgery. Mechanical ventilation was given during general anesthesia and surgery, and the indices of hemodynamics and respiratory function were measured at 5 min before induction, 1 min before the start of surgery, 30, 60, 120 and 180 min after the start of surgery and at the end of surgery, respectively. Results Mean arterial pressure (MAP) in the 2 groups did not undergo any conspicuous changes during general anesthesia and surgery (P>0.05), and the heart rate in child group was markedly faster than that in adult group during the whole course (P<0.01). Oxygen consumption (VO 2 ) in 2 groups at 1 min before the start of surgery and 30 min after the start of surgery was significantly higher than that at 5 min before induction (P<0.01), and at these two time points after induction, child group had much higher VO 2 (P<0.05) but evidently lower OCB (P<0.01) than in adult group, the latter index remained low till 60 and 120 min after the start of surgery (P<0.05). Conclusion During anesthesia and surgery, VO 2 in child group can be much greater than that in Adult group, while OCB markedly lower.