不同氧流量对上腹部手术全身麻醉患者苏醒期影响.docVIP

不同氧流量对上腹部手术全身麻醉患者苏醒期影响 　 作者：赵连英　类维富　吴小鹏 【摘要】 目的： 探讨不同氧流量机械通气对外科手术全麻病人苏醒期的影响。方法：择期全麻下行腹部手术病人48例，ASAⅠ~Ⅱ级，年龄33~68岁，平均50.5岁。随机分为3组，每组16例。Ⅰ组，于手术结束前30分钟开始降低安氟醚用量，每10~15 min降低0.3~0.5vol%,术毕维持基准氧流量（2 L/min）不变，Ⅱ组，术毕氧流量4 L/min，Ⅲ组，术毕氧流量10 L/min，其余各呼吸参数保持不变。术中连续监测血压、心率、心电图及脉搏血氧饱和度，连续监测吸入安氟醚浓度（Fi）和呼气末安氟醚浓度（Fa），记录停吸前即刻安氟醚浓度（Fao）及每隔1min的Fa，直至苏醒，并计算各时点的Fa/ Fao；记录苏醒时间，并对所有病人术前和术后进行简易精神评分。结果:Ⅰ组患者Fa/ Fao与Ⅱ、Ⅲ组相比有明显统计学差异；简易精神评分Ⅰ组与Ⅱ组、Ⅲ组相比有统计学意义；苏醒时间各组之间无统计学差异。结论： 全麻苏醒期维持基准氧流量不变，有可能降低苏醒期谵妄发生率，但不影响外科手术全麻病人苏醒时间。 【关键词】 外科手术·麻醉药，吸入·苏醒·谵妄 【ABSTRACT】 Objective: To investigate effects of different frash gas flow of oxygen ventilation on emergence time and delirium undergoing Enflurane general anesthesia. Methods: Forty-eight patients, ASA Ⅰ- Ⅱ, aged 33-68yr, mean 50.5yr, underwent elective abdominal operation were randomly divided into three groups according to the different frash gas flow at the end of operation: GroupⅠ, the flow of oxygen maintained at 2 L/min, GroupⅡ 4 L/min, GroupⅢ 10 L/min. Anesthesia was induced with intravenous midazolam 0.08-0.1mg/kg, etomidate 15-20mg,fentanyl 3-4 μg/kg, pipecuronium 0.08-0.1mg/kg and maintained with Enflurane （1.5-2.0vol%）, supplemented with intermittent iv pipecuronium and fentanyl. The concentration of Enflurane was monitored continuous which involved Fi, Fa and Fao, originated from inspiration, expiration and the moment expiration when stopped inhalation. Accounted Fao and after this detailed every one minute Fa until the patients recovery and calculated Fa/Fao ratio. Emergence time was recorded. Mini-Mental State Examination（MMSE） was performed before anesthesia and after surgery. Results： Fa/Fao ratio in GroupⅠ was significantly defferent from GroupⅡ and Ⅲ. MMSE scores in GroupⅠwere higher compare with GroupⅡand Ⅲ after surgery. Emergence time was no significantly difference among three groups. Conclusion : The frash gas low flow of oxygen ventilation might reduce the incidence of delirium,but does not influnce the time of emergence from genera