低潮气量机械通气对慢性肺病患者全麻术中肺呼吸保护作用.docVIP

低潮气量机械通气对慢性肺病患者全麻术中肺呼吸保护作用[摘要] 目的：观察低潮气量加低水平呼气末正压通气在慢性肺部疾病患者全麻手术中对肺呼吸功能的影响。方法：将慢性肺部疾病拟行非肺部手术患者100例，随机分为保护性通气组和常规通气组，每组各50例。保护性通气组（A组），通气模式采用低潮气量加低水平呼气末正压（PEEP）机械通气；常规通气组（B组），采用常规方法通气。分别于麻醉诱导前（T0）、机械通气1 h（T1）、拔管后15 min（T2）、术后6 h（T3）采动脉血行血气分析，并记录各时点的动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、气道峰压（Ppeak）、气道平台压（Pplat）、平均动脉压（MAP）。结果：T1、T2、T3时A组PaO2水平高于B组，T1时A组Ppeak、Pplat低于B组，差异有统计学意义（P＜0.05）；两组各时点PaCO2、MAP比较，差异无统计学意义（P＞0.05）。结论：慢性肺部疾病患者全麻手术中，低潮气量加低水平呼气末正压通气的肺保护性通气策略对肺的呼吸功能有保护作用。 [关键词] 低潮气量；呼气末正压；全身麻醉；慢性肺部疾病；呼吸功能 [中图分类号] R563.8 [文献标识码] A [文章编号] 1673-7210（2011）11（a）-104-03 The efficacy of low tidal volume mechanical ventilation on pulmonary respiration protection of patients with chronic lung disease during general anesthesia WEI Zhihui, ZHANG Haiqing, HAN Tian Department of Anesthesiology, the Second Center Hospital of Baoding City, Heibei Province, Baoding 072750, China [Abstract] Objective: To observe the efficacy of low tidal volume plus low positive end expiratory pressure mechanical ventilation on respiratory function of patients with chronic lung disease during general anesthesia. Methods: 100 cases of patients with chronic lung disease who underwent non-lung surgery were randomly divided into protective ventilation group and conventional ventilation group, each of 50 cases. Low tidal volume ventilation plus low positive end expiratory pressure mechanical ventilation were adopted in protective ventilation group (group A); conventional ventilation treatment was adopted in conventional ventilation group (group B). Arterial blood gas analysis were conducted before induction of anesthesia (T0), 1 h after mechanical ventilation (T1), 15 min after extubation (T2), 6 h after operation (T3) respectively, and PaO2, PaCO2, Ppeak, Pplat, MAP were recorded. Results: At the time of T1, T2 and T3, PaO2 of group A was higher than that of group B (P0.05），具有可比性。见表1。 1.2 麻醉方法 患者麻醉前30 min，肌注地西泮10 mg，东莨菪碱1 mg。入手术室后连续监测血氧饱和度（SpO2）、心电图（ECG）、血压（BP），呼末二氧化碳分压（PETCO2）