(A Report of 74 Case of Arterial Blood Gas Analysis) Shanghai Chest Hospital
This article reports on the gas analysis of arterial blood in 74 cases and the oxygen consumption in 9 cases undergoing commissurotomy under acupuncture anesthesia. The clinical effects of the respiratory management has been studied within the following three groups: supply oxygen by intubation, pressurized mask, and natural respiration.
1. In spite of the size of stenosis, the PO[2] would be higher than 155 mm Hg if oxygen was given before operation; it was lower than 85 mm Hg if no oxygen was given. (t=3.46 df=30 p<0.01)
2. PaO[2] and PaCO[2] remained in the normal ranges for the three groups. However the BE value reached -6.1mEq/L. in cases with the mitral orifice diameter under 0.7 cm. and in natural respiration group, whereas in intubation group was -2.22 mEq/L.
3. The gas analysis before commissurotomy and before closing thorax showed that the metabolic index in intubation group was stable although their orifice diameter was under 0.7 cm., while in natural respiratory group, its BE value dropped from -5.76 to -6.10, and pH from 7.35 to 7.31 in cases with diameter under 0.7 cm.
4. The oxygen partial pressure was the highest (265.75) when the lung was in full expansion, less (208.38) when it was completely collapsed, and the lowest (106.50) when it was partially collapsed.
Most cases in full lung expansion belonged to the intubation group (77.5%), and the other two kinds mostly belonged to the non-intubation group (89.28%) (p<0.01).
5. The oxygen consumption value in mask group was 472.80 ml, like that before operation, while in natural respiratory group, it rose up to 918.75 ml (p>0.05).
Conclusion:
1. The average value of blood gas analysis was normal in intubation group, while in the other two groups, though their PaO[2] and PaCO[2] kept normal, yet metabolic acidosis occurred, it is especially obivious in those cases whose mitral orifice was under 0.7 cm. In natural respiration group, the consumption value after thoracotomy was twice than that before operation, the increase of acidosis and oxygen consumption may be related to an augmented activity of respiratory muscles.
2. Results of blood gas analysis were obviously affected by the use or non-use of oxygenation, the ways and means of supplying oxygen, the condition of diseases and the degree of pulmonary collapse. Therefore, it was suggested, that we should strictly control the respiration during thoracotomy under acupuncture anesthesia, including the supply of oxygen before operation. For those cases whose orifice was under 0.7 cm, we should lay stress on the necessity of intubation, the assisted or control of respiration and the mantainance of the complete expansion during operation.
3. Assisted respiration by mask could reduce oxygen consumption. It is useful to supply oxygen, when patients appear to be in dyspnea during thoracotomy.
This article reports on the gas analysis of arterial blood in 74 cases and the oxygen consumption in 9 cases undergoing commissurotomy under acupuncture anesthesia. The clinical effects of the respiratory management has been studied within the following three groups: supply oxygen by intubation, pressurized mask, and natural respiration.
1. In spite of the size of stenosis, the PO[2] would be higher than 155 mm Hg if oxygen was given before operation; it was lower than 85 mm Hg if no oxygen was given. (t=3.46 df=30 p<0.01)
2. PaO[2] and PaCO[2] remained in the normal ranges for the three groups. However the BE value reached -6.1mEq/L. in cases with the mitral orifice diameter under 0.7 cm. and in natural respiration group, whereas in intubation group was -2.22 mEq/L.
3. The gas analysis before commissurotomy and before closing thorax showed that the metabolic index in intubation group was stable although their orifice diameter was under 0.7 cm., while in natural respiratory group, its BE value dropped from -5.76 to -6.10, and pH from 7.35 to 7.31 in cases with diameter under 0.7 cm.
4. The oxygen partial pressure was the highest (265.75) when the lung was in full expansion, less (208.38) when it was completely collapsed, and the lowest (106.50) when it was partially collapsed.
Most cases in full lung expansion belonged to the intubation group (77.5%), and the other two kinds mostly belonged to the non-intubation group (89.28%) (p<0.01).
5. The oxygen consumption value in mask group was 472.80 ml, like that before operation, while in natural respiratory group, it rose up to 918.75 ml (p>0.05).
Conclusion:
1. The average value of blood gas analysis was normal in intubation group, while in the other two groups, though their PaO[2] and PaCO[2] kept normal, yet metabolic acidosis occurred, it is especially obivious in those cases whose mitral orifice was under 0.7 cm. In natural respiration group, the consumption value after thoracotomy was twice than that before operation, the increase of acidosis and oxygen consumption may be related to an augmented activity of respiratory muscles.
2. Results of blood gas analysis were obviously affected by the use or non-use of oxygenation, the ways and means of supplying oxygen, the condition of diseases and the degree of pulmonary collapse. Therefore, it was suggested, that we should strictly control the respiration during thoracotomy under acupuncture anesthesia, including the supply of oxygen before operation. For those cases whose orifice was under 0.7 cm, we should lay stress on the necessity of intubation, the assisted or control of respiration and the mantainance of the complete expansion during operation.
3. Assisted respiration by mask could reduce oxygen consumption. It is useful to supply oxygen, when patients appear to be in dyspnea during thoracotomy.
No comments:
Post a Comment