中心静脉压和气道压监测在经皮肾碎石术中应用.docVIP

中心静脉压和气道压监测在经皮肾碎石术中的应用 　　【摘要】目的:通过对经皮肾镜碎石术麻醉期间持续气道压和中心静脉压的监测,预防和治疗可能出现的灌流液吸收综合征。方法:选择ASAⅠ或Ⅱ级择期上尿路结石经皮肾镜碎石术病人30例,实施全身麻醉,用力月西0.1mg.kg??-1?、异丙酚1.5mg.kg??-1?、顺苯磺酸阿曲库铵0.15mg.kg??-1?、芬太尼4μg.kg??-1?麻醉诱导,七氟醚1~1.3MAC持续吸入维持麻醉。分别测定术前、手术俯卧位、手术0.5小时、1小时、1.5小时、2小时或手术结束时、气道压(Paw)、中心静脉压(CVP)和血压(MBP)的值。结果:30例患者中29例顺利完成手术,手术时间90～150min,平均(118.97±13.58)min,冲洗液18000～29000ml,平均(23106.89±3543.70)ml,30例病人均痊愈出院;术中HR变化差异无显著性;与术前相比Paw T??4?、CVP T??3?、MBP T??4?、T??5?有明显的升高,差异有显著性P0.05,CVP T??4?、T??5?有明显的升高,差异有显著性P0.01。结论:CVP和Paw随手术时间的延长而升高,对CVP和Paw严密观察有助于预防灌流液吸收综合征的发生,对于较难处理的结石,或者估计手术时间长者,建议行分期手术,以提高病人的安全性。? 　　【关键词】经皮肾镜碎石术;气道压;中心静脉压? 　　doi:10.3969/j.issn.1006-1959.2010.08.089文章编号:1006-1959(2010)-08-2069-02? 　　 　　Evaluate monitoring of central venous pressure and airway pressure in Percutaneous nephrolithotripsyWU Li-xin,LIANG Jing-zhu,ZHANG Zhi-ang,LING-Quan,ZHANG Chun-yuanDepartment of Anesthesiology、Zhongshan peoples hospital,Zhongshan 528400,china? 　　【Abstract】Objective:To evaluate central venous pressure and airway pressure monitoring using in percutaneous nephrolithotripsy to Prevention and therapy perfusate absorbing sydrome.Methods:30 patients with calculus of kidney of ASAⅠorⅡ level were selected.After general anaesthesia,Anesthesia was induced with midazolam 0.1mg.kg??-1?,diprivan 1.5mg.kg??-1?,cisatracurium besilate 1.5mg.kg??-1?and fentanyl 4μg.kg??-1?.sevoflurane 1~1.3MAC to maintain anesthesia.we detected the central venous pressure,airway pressure and blood pressure at preoperative,operation beginning,0.5 hour,1 hour,2hour,2.5hours and the end of operation.Results:29 operation of 30 cases were completed successfully.Average time was (118.97±13.58)min and washing fluid was(23106.89±3543.70)ml,all these 30 patients were cured.During the operation there was no significance changes in HR,but Paw T??4?、CVP T??3?、MBP T??4?、T??5? significantly step-up (P0.05).Conclusion:CVP and Paw raised with the operation time going on.So keep detecting of CVP and Paw can prevent patients from