全凭静脉麻醉患者拔除气管导管后血气分析值的变化趋势

目的:对接受静脉麻醉进入麻醉后监护室的患者在拔除气管导管后进行血气分析,试图揭示各血气参数的变化趋势及其影响因素。方法:选择ASA分级1~3级接受静脉麻醉的择期患者168例,常规诱导插管后,丙泊酚-雷米芬太尼复合术中维持。术毕带管回麻醉后监护室,拔管后行面罩给氧。5 min及1 h后抽取桡动脉血行血气分析。结果:患者拔管后即刻PaCO2升高pH降低,均显著偏离正常范围,1 h后此两参数恢复正常,且PaO2和HCO3也较前有所改善。拔管后即刻,60岁以上患者较60岁以下患者PaCO2更高而pH更低,1 h后此差异消失。女性PaO2于拔管后即刻和拔管1 h后均高于男性。手术时间与ASA分级对拔管后各血气参数的影响不大。结论:患者拔管后PaCO2总体水平仍高于正常范围,并存在酸血症倾向,因此实施呼吸监护非常必要。

Change Trending of Blood Gas Analysis of Patients with Intravenous Anesthesia Only after Extubation

Objective：To investigate the trend of blood gas parameters such as PaO2 ,PaCO2 and pH in the post-anesthesia care unit （PACU） and the affected factors. Methods： 168 patients with ASA classification 1-3 undergoing elective operations were enrolled in this study. After anesthesia induction and endotracheal intubation, the patients received standard propofol-remifentanil intravenous anesthesia. After operation,the patients were sent to PACU there tracheal extubations were made and supplementary oxygen was given via masks. Radical blood gas analysis was made 5 min late and repeated 1h later. Results： After tracheal extubation PaCO2 was increased, and pH was decreased significantly. Both of them were deviated from the normal ranges. One hour later these two. parameters returned to normal. PaO2 and HCOs were also improved 1h later. After tracheal extubation, the patients aged above 60yrs would be a higher PaCO2 and lower pH in comparing to those aged below 60 yrs. Their differences disappeared 1 h later after tracheal extubation. The female patients had a higher PaO2 than those males on both the stages of immediate or 1 h after the tracheal extubation. Such factors as operation time and ASA classification showed no significant relations to these blood gas parameters. Conclusions： The patients still showed hypercapnia and blood acidosis in spite of oxygen inhalation via mask after tracheal extubation. Close respiratory care is necessary for these patients just after tracheal extubation.