Effects of preoperative respiratory exercise on respiratory function during anesthesia recovery period in morbidly obese patients
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摘要: 目的 观察术前呼吸功能锻炼对病态肥胖患者全麻苏醒期呼吸功能的影响。方法 选取择期行腹腔镜下胃减容术的病态肥胖患者70例,采用随机数字表法分为锻炼组和对照组,每组35例。对照组入院后进行常规术前护理;锻炼组在对照组基础上增加术前2周呼吸功能锻炼。分别于入室时(T0)、气管插管后(T1)、气腹结束后10 min(T2)、气管导管拔除前(T3)、拔管后吸氧10 min(T4)和出PACU时(T5)抽取桡动脉血行血气分析,记录二氧化碳分压(PaCO2)和pH,计算氧合指数(PaO2/FiO2);记录术毕至气管导管拔除时间、PACU停留时间,拔管后吸空气时SpO2的下降时间(99％降至92％),吸氧后SpO2的上升时间(92％升至99％);记录T3、T4、T5时间点PaO2/FiO2＜300 mmHg的患者例数;PACU内不良事件发生情况。结果 与对照组相比,锻炼组T3、T4、T5时点PaO2/FiO2升高,术毕至气管导管拔除时间、PACU停留时间和吸氧后SpO2的上升时间明显缩短,拔管后SpO2的下降时间明显延长, T5时点PaO2/FiO2＜300 mmHg的发生率明显降低,差异有统计学意义(P＜0.05)。2组在T0～T2时点PaO2/FiO2及各时点的PaCO2和pH水平及PACU内不良事件的发生率比较,差异无统计学意义(P>0.05)。结论 术前呼吸功能锻炼可有效改善病态肥胖患者苏醒期氧合,促进呼吸功能恢复,值得在临床中广泛应用。Abstract: Objective To investigate the effects of preoperative respiratory exercise on respiratory function during anesthesia recovery period in morbidly obese patients. Methods A total of 70 morbidly obese patients who were scheduled to undergo laparoscopic bariatric surgery were randomly divided into two groups (n=35): an exercise group (Group T) and a control group (Group C). Group C was treated with routine preoperative care methods after admission. Group T was given preoperative respiratory exercise on the basis of the Group C for two weeks. The blood gas of the radial artery was analyzed before oxygen inhalation (T0), after tracheal intubation (T1), at 10 min after pneumoperitoneum withdrawal (T2), before extubation (T3), at 10 min of oxygen inhalation after extubation (T4), and before discharging from the post anesthesia care unit (PACU) (T5). The partial pressure of carbon dioxide (PaCO2) and pH were recorded, and the oxygenation index (PaO2/FiO2) was calculated at six time points. The times from the end of the operation to the extubation of tracheal tube and the length of stay in PACU were recorded. After extubation, we also recorded the time for SpO2 decreased from 99% to 92% with air and the time for SpO2 increased from 92% to 99% after oxygen inhalation. Meanwhile, the number of patients with PaO2/FiO2＜300 mmHg at T3, T4, and T5 and the occurrence of adverse events in PACU were recorded. Results Compared with Group C, PaO2/FiO2 was increased obviously(T3, T4, T5), the time from the end of the operation to the extubation of tracheal tube, the length of stay in PACU and the time for SpO2 increased from 92% to 99% after oxygen inhalation were significantly shorter, the time for SpO2 decreased from 99% to 92% with air was obviously longer, the incidence of PaO2/FiO2＜300 mmHg at T5 was decreased significantly (P＜0.05). There was no significantly difference between the two groups in PaO2/FiO2 at T0-T2, PaCO2 and pH at all time points, and the incidence of adverse events in PACU (P＞0.05). Conclusions Preoperative respiratory exercise can effectively improve oxygenation and promote the recovery of respiratory function during anesthesia recovery period in morbidly obese patients. It is worthy of clinical application.
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