高原地区非全麻患者术中脉搏血氧饱和度与吸氧流量的相关性研究

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相关性研究

谢小伟1，2，罗珍2，李武军3*

（1.陕西省宝鸡市中心医院麻醉手术科，陕西宝鸡，721008；2.西藏阿里地区人民医院麻醉科，西藏阿里，859000；

3.西安医学院第一附属医院普通外科，陕西西安，710000）

临床手术过程中的给氧（吸氧）是一项必要的支持和治疗手段，特别是对于合并有心肺功能疾病的老年患者来说尤为重要。不论是全身麻醉气管插管后正压通气，还是非全身麻醉下患者自主呼吸吸氧，都可以明显地提高患者血液中血红蛋白的携氧能力，使动脉血氧分压和氧饱和度升高，从而为脑组织、心脏、肾脏等全身各个脏器提供充足的氧供。

西藏阿里地区平均海拔4500m以上，大气压力低，空气中的氧含量只有海平面的60%左右。因此，当地居民血液中的氧含量也与低海拔地区居民相差甚远[1]，所以在手术过程中对高海拔地区患者进行氧疗就显得尤为必要。本文旨在观察阿里地区人民医院（海拔4300m）非全身麻醉的手术患者在术中自主呼吸情况下，在不吸氧以及吸入不同流量的氧气时，脉博

摘要：目的探讨不同氧流量吸氧对在非全身麻醉下行各种手术的高原地区患者术中脉博血氧饱和度（SpO2）的影响。方法选取西藏阿里地区人民医院2017年8月至2017年10月在硬膜外麻醉、脊麻、硬—腰联合麻醉，以及颈丛、臂丛神经阻滞麻醉下行各类手术的患者共60例，分别记录每例患者进入手术室后未吸氧状态下的SpO2，然后进行麻醉操作；麻醉完成后给予双腔鼻导管吸氧，分别记录氧流量从1L/min逐渐增加至8L/min各氧流量吸氧5min后的SpO2值。将记录到的不同时段的SpO2值进行统计分析。然后利用不同氧流量吸氧时SpO2的平均值绘出氧流量与SpO2值的关系图。结果所有患者在给予双腔鼻导管吸氧后，SpO2值均有不同程度升高；随着吸氧流量的增大，SpO2值也逐渐增高。但是当氧流量>5L/min时，SpO2值不再随着吸氧流量的增加而增高，出现“封顶效应”；当低流量（1L/min和2L/min）吸氧时，SpO2值升高最为明显，而氧流量为3

L/min和4L/min时，SpO2值已经接近低海拔地区健康人群的正常值。不吸氧组（0L/min组）、1L/min组、2L/min组的SpO2值与其他组比较，差异有统计学意义（P<0.05）。结论西藏阿里地区（海拔4300m）非全身麻醉患者术中鼻导管吸氧时最合理、经济、有效的氧流量为3~4L/min，封顶效应出现在5L/min。

关键词：脉搏血氧饱和度；氧流量；高原地区

中图分类号：R614文献标志码：A文章编号：2096-1413(2018)04-0001-03

Study on correlation between pulse oxygen saturation and oxygen flow of intraoperative

general anesthesia patients in plateau region

XIE Xiao-wei1,2,LUO Zhen2,LI Wu-jun3*

(1.Anesthesia Surgery Department,Baoji Central Hospital,Baoji721008;2.Anesthesiology Department,the People's Hospital of Ali District,Ali859000;3.General Surgery Department,the First Affiliated Hospital of Xi'an Medical University,Xi'an710000,China) ABSTRACT:Objective To study the influence of different oxygen flow on the intraoperative pulse oxygen saturation(SpO2) of non-general anesthesia patients in the plateau region.Methods Sixty cases of patients underwent surgery under epidural anesthesia,spinal anesthesia,hard-lumbar anesthesia,cervical plexus and brachial plexus block anesthesia at the People's Hospital of Ali District in Tibet from August2017to October2017were selected.The SpO2were recorded in each patients after entering the operating room without oxygen inhalation,then followed by anesthesia,and given double nasal cannula oxygen.The SpO2values at5min after oxygen inhalation in oxygen flow from1L/min to8L/min were respectively recorded.Then the mean value of SpO2in different oxygen flow were used to draw the correlation between oxygen flow and SpO2value.Results The SpO2values of all patients increased in different extents after being given oxygen in double-lumen nasal cannula.And with the increasing of oxygen flow rate,the SpO2value also increased.However,when the oxygen flow was greater than5L/min,the SpO2value no longer increased with the increase of oxygen flow rate,and there was a" capping effect".When oxygen flow rate was1L/min and2L/min,the SpO2value rises most notably;when the oxygen flow rate was3L/min and4L/min,the SpO2value was already close to normal value of the healthy population at low altitude. The SpO2values in non-oxygen group(0L/min group),1L/min group and2L/min group were significantly different from other groups(P<0.05).Conclusion The most reasonable and economical oxygen delivery rate for non-general anesthesia patients under nasal cannula in Ali area(4300m above sea level)is3-4L/min and the capping effect is5L/min.

KEYWORDS:pulse oxygen saturation;oxygen flow;plateau area

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