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为比较矽肺患者与心、肺功能正常者全麻诱导后无通气期安全时限的差别,选择拟行大容量肺灌洗术的Ⅰ~Ⅲ期矽肺患者48例为矽肺组,术前心、肺功能正常拟行腹腔镜胆囊切除术的成年男性患者35例为对照组。全部患者自主呼吸状态下,平静吸氧5 min完成自主呼吸预氧合,然后于1 min内快速静脉注射2,6-二异丙基苯酚注射液2 mg/kg,氯化琥珀胆碱注射液1 mg/kg,待自主呼吸消失后移除吸氧面罩,同时静注维库溴胺注射液0.1 mg/kg确保自主呼吸消失,保持气道向空气开放(不接麻醉机停止通气),直至脉搏氧饱和度(SpO2)降至92%为止。记录每例患者自主呼吸消失至SpO2降至95%、92%的时间。结果显示,矽肺组患者较对照组年轻,但血红蛋白(Hb)显著高于对照组;自主呼吸消失至SpO2降至95%、92%的时间,矽肺组均显著短于对照组,差异有统计学意义(P<0.01)。提示,矽肺患者较心、肺功能正常者无通气期安全时限明显缩短,说明其氧储备能力下降,全麻下大容量肺灌洗时应高度警觉SpO2变化。
In order to compare the difference between the safety limits of ventilatory periods after induction of general anesthesia with normal heart and pulmonary function in patients with silicosis, 48 patients with stage Ⅰ ~ Ⅲ silicosis who underwent massive lavage were selected as silicosis group, preoperative heart and lung 35 cases of adult male patients with normal function undergoing laparoscopic cholecystectomy as control group. All patients under spontaneous breathing, calm oxygen inhalation 5 min to complete spontaneous breathing preoxygenation, and then within 1 min rapid intravenous injection of 2,6-diisopropylphenol injection 2 mg / kg, succinylcholine chloride injection 1 mg / kg, to be spontaneous breathing disappear after removal of oxygen masks, intravenous injection of vecuronium injection 0.1 mg / kg to ensure spontaneous breathing disappear, keep the airway open to the air (without anesthesia stop ventilation) until Pulse oxygen saturation (SpO2) down to 92% so far. Record spontaneous respiration in each patient disappeared to SpO2 dropped to 95%, 92% of the time. The results showed that silicosis patients were younger than the control group, but hemoglobin (Hb) was significantly higher than that of the control group; spontaneous respiration disappeared to SpO2 decreased to 95%, 92% of the time, silicosis group were significantly shorter than the control group, the difference was statistically Significance (P <0.01). Tip, silicosis patients with heart, lung function was normal without ventilation period was significantly shorter safety margin, indicating that its ability to reduce oxygen reserves, high-capacity lung lavage under general anesthesia should be highly alert SpO2 changes.