Correlation Between Obesity and Oxygen Reserve during Induction of General Anesthsia
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摘要:
目的 研究不同体重全麻诱导无通气期耐受缺氧的时限，以探讨肥胖患者的氧储备能力。 方法 美国麻醉医师协会（ASA）分级Ⅰ～Ⅱ级择期手术患者43例，年龄20～50岁，根据体重指数（BMI）进行分组 （A组：BMI≤25 kg/m2；B组：BMI 25.1～29.9 kg/m2；C组：BMI≥30 kg/m2）。所有紧闭面罩吸纯氧5 min（氧流量10 L/min），常规药物麻醉诱导后，呼吸停止立即作机控正压通气（VT：8 mL/kg，R：12次/min，PEEP：5 cm H2O）3 min，在可视喉镜下气管插管一次成功。暂不连接麻醉机通气环路，直至SpO2降至93%时迅速接上环路行机械通气。记录诱导前、SpO2由100%降至97%时、SpO2降至93%时3个时刻的以下数据：体重指数、心率、血压、SpO2，以及停止给氧即刻SpO2由100%降至97%和93%的时间（T97、T93）。 结果 三组安全时限T97、T93比较，差异有统计学意义（P < 0.01），T97、T93与BMI呈负相关（P < 0.05）。 结论 随着BMI 的增大，无通气安全时限明显缩短。 Abstract:Objective To study the duration of anoxia tolerance in patients with different weight, so as to discuss obese patients with oxygen reserve capacity. Methods Twenty-two aldut patients undergoing elective surgery, ASAⅠ～Ⅱ, aged 20～50, were divided into 3 groups according to Body Mass Index （BMI = High/Weight2）: group A （BMI≤25 kg/m2）, group B （BMI25～29.9 kg/m2） and group C （BMI≥30 kg/m2）. Each patients received routine induction, while respiratory arrest control ventilation （VT: 8 mL/kg, R: 12次/min, PEEP: 5 cm H2O）. Glidescope to trachea intubation in two minutes, fiber bronchoscope to ensure the position of the endotracheal tube without error quickly and fix the endotracheal tube. No patients were not ventilated until SpO2 decreased to 93%. Baseline BMI, HR, blood pressure, SpO2, the duration of SpO2 fell from 100% to 97% and 93% （T97, T93）. Results There were statistically significant differences in the airless safety time T97, T93 between the three groups of patients. BMI and T97 and T93 had negative correlation with BMI. Conclusion With the increase of BMI in twenty-two patients, the airless safety time will be shortened significantly. -
Key words:
- Obesity /
- Oxygen reserve /
- Induction of general anesthsia
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表 1 三组患者一般资料比较（
$\bar x \pm s$ ）Table 1. Comparison of general data among patients in three groups （
$\bar x \pm s$ ）组别 n 性别比（男/女） 年龄（岁） BMI（kg/m2） 术前血红蛋白值（g/L） 术前SpO2值（%） ASA分级（Ⅰ/Ⅱ） A组 15 7/8 37.9 ± 5.0 21.15 ± 1.62 136.8 ± 14.3 97.1 ± 1.0 8/7 B组 15 8/7 37.8 ± 5.5 28.21 ± 1.10 139.7 ± 15.8 96.21 ± 1.3 7/8 C组 13 7/6 37.2 ± 5.6 31.62 ± 0.54 142.4 ± 15.0 95.6 ± 1.0 5/8 
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表 2 三组无通气期耐受缺氧时限比较[（
$\bar x \pm s$ ），${\rm{s}}$ ]Table 2. Comparison of duration of anoxia tolerance during noventilation among patients in three groups [（
$\bar x \pm s$ ），${\rm{s}}$ ]组别 SpO2降到97%的时间（T97） SpO2降到93%的时间（T93） SpO2降至97%与93%的时间差 A组 260 ± 13 305 ± 9 45 ± 10 B组 218 ± 15* 261 ± 17* 43 ± 12 C组 156 ± 22*Δ 194 ± 19*Δ 38 ± 8*Δ 与A组同时间段比较，* P < 0.05；与B组同时间段比较，ΔP < 0.05。
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表 3 动脉血气分析比较（
$\bar x \pm s$ ）Table 3. Comparison the data of arterial blood gas analysis among patients in three groups （
$\bar x \pm s$ ）指标 组别 例数（n） T1 T100 T93 PaO2（mmHg） A组 15 78 ± 7 453 ± 84 66 ± 6 B组 15 72 ± 8 408 ± 62* 66 ± 8 C组 13 68 ± 8* 347 ± 73*Δ 65 ± 5 PaCO2（mmHg） A组 15 37.8 ± 6.1 38.6 ± 4.5 50.8 ± 7.0 B组 15 36.9 ± 5.2 40.7 ± 6.1 55.1 ± 6.3 C组 13 36.1 ± 4.8 44.2 ± 5.8 59.2 ± 6.1* pH A组 15 7.404 ± 0.028 7.398 ± 0.031 7.323 ± 0.048 B组 15 7.421 ± 0.019 7.392 ± 0.056 7.298 ± 0.036 C组 13 7.418 ± 0.032 7.356 ± 0.029 7.276 ± 0.023* 与A组同时间点比较，*P < 0.05；与B组同时间点比较，Δ P < 0.05。
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