外科理论与实践

外科理论与实践 ›› 2019, Vol. 24 ›› Issue (02): 155-158.doi: 10.16139/j.1007-9610.2019.02.014

• 论著 • 上一篇    下一篇

不同吸氧流量对高海拔高原地区病人术后血氧饱和度的影响

谢小伟1,4, 李武军2,4, 赵海3,4, 王庭辉4   

  1. 1.陕西省宝鸡市中心医院麻醉手术科,陕西 宝鸡 721008;
    2.西安医学院第一附属医院普外科,陕西 西安 710007;
    3.陕西省人民医院检验科,陕西 西安 710000;
    4.西藏阿里地区人民医院,西藏 阿里 859000
  • 收稿日期:2018-06-26 出版日期:2019-03-25 发布日期:2019-04-25
  • 通讯作者: 赵海,E-mail: sunsea1985@126.com
  • 基金资助:
    西藏自治区2017年“组团式援藏”医学项目（XZ2017ZR-ZYZ38）

Effect of different flow of oxygen on postoperative oxygen saturation of patients in high altitude area

XIE Xiaowei1,4 , LI Wujun2,4, ZHAO Hai3,4, WANG Tinghui4   

  1. 1. Department of Anesthesiology and Operation, Baoji Central Hospital, Shaanxi Province, Shaanxi Baoji 721008, China;
    2. Department of General Surgery, the First Affiliated Hospital of Xi'an Medical University, Shaanxi Xi'an 710007, China;
    3. Department of Clinical Laboratory, Shaanxi Provincial People's Hospital, Shaanxi Xi'an 710000, China;
    4. Ali District People's Hospital of Tibet, Tibet Ali 859000, China
  • Received:2018-06-26 Online:2019-03-25 Published:2019-04-25

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摘要： 目的 探讨高海拔高原（海拔>4 000 m）地区全身麻醉手术病人,不同吸氧流量对于术后血氧饱和度（saturation of peripheral oxygen, SpO2）的影响。方法 选取西藏阿里地区人民医院2017年8月至2018年4月在气管插管全身麻醉下手术的80例病人。采用随机数字表法,分为4组：拔管后2 L/min吸氧为L1组,4 L/min吸氧为L2组,6 L/min吸氧为L3组,8 L/min吸氧为L4组,每组各20例。分别记录进入手术室后未吸氧时（T0）的SpO2 ,以及苏醒拔管后,给予口鼻面罩吸氧30 min、1 h、2 h、4 h、24 h时的SpO2。结果 本研究男47例,女33例,年龄19~58岁,体重48~72 kg,术前评估病人为美国麻醉医师学会Ⅰ、Ⅱ级。所有病人术后拔管给予面罩吸氧,SpO2较术前均有升高（P<0.05）。吸氧流量为2 L/min时,SpO2处于较低水平。吸氧流量为4 L/min时,SpO2已接近低海拔地区健康人群正常值。吸氧流量≥6 L/min时,SpO2不再随吸氧流量的增加而升高。吸氧4 h后,L3、L4组与L2组比较,SpO2差异无统计学意义（P>0.05）,吸氧流量可降低至4 L/min。继续吸氧至术后24 h,L1组SpO2为94.86%,接近富氧环境的95%。因此,吸氧流量24 h后可降为2 L/min。结论 高海拔高原地区全身麻醉病人术后早期吸氧流量建议≥6 L/min。此后可以降至4 L/min和2 L/min,避免高流量氧的浪费和氧中毒风险。

关键词: 脉搏血氧饱和度, 氧流量, 高海拔高原地区, 全身麻醉

Abstract: Objective To study the effect of oxygen therapy by different flow on pulse arterial oxygen saturation (SpO2) of postoperative patients of general anesthesia in high altitude area. Methods Eighty cases with operation under general endotracheal anesthesia were enrolled in the study between August 2017 and April 2018 in Ali district People's Hospital of Tibet. By random number table, the patients were divided into 4 groups according to oxygen flow after extubation including 2 L/min (group L1), 4 L/min (group L2), 6 L/min (group L3) and 8 L/min (group L4). SpO2 was recorded as baseline before operation without oxygen inhalation and 30 min, 1 h, 2 h, 4 h or 24 h later after oxygen inhalation with oral and nasal mask ventilation. Results There were 47 male and 33 female cases with age range 19-58 years and weight 48-72 kg. The level of American Association of Anesthesiologists was grade Ⅰ-Ⅱ preoperatively. All the SpO2 of cases was higher by oxygen therapy with oral and nasal mask after extubation of general anesthesia than before surgery (P< 0.05). SpO2 remained lower level at oxygen flow 2 L/min and was close to healthy people in low altitude areas at 4 L/min. However, SpO2 increased no longer when oxygen flow increased to 6 L/min or more. There was no significant difference in oxygen saturation between group L2 and group L3 and between group L2 and group L4 (P> 0.05) after 4 hours of intake oxygen. Therefore oxygen flow could be reduced to 4 L/min. When patients intaked oxygen for 24 h after surgery, SpO2 in group L1 was 94.86% which is close to 95% the SpO2 of healthy people. We recommended that oxygen flow could be reduced to 2 L/min 24 h later. Conclusions Early oxygen intake in patients with general anesthesia in high altitude areas need 6 L/min of oxygen flow or more. Thereafter, it can be reduced to 4 L/min and 2 L/min for avoiding the waste of high flow oxygen and the risk of oxygen poisoning.

Key words: Pulse oximetry, Oxygen flow, High altitude area, General anesthesia

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