通气时间对人工鼻两端阻力影响.docVIP

通气时间对人工鼻两端阻力影响 　　【摘 要】 目的：探讨长时间机械通气对人工鼻两端气道峰压的影响。方法：择期全身麻醉下手术患者100例，ASA分级Ⅰ或Ⅱ级，采用随机数字表法，将其分为2组（n=50）：A组和B组。全麻诱导气管插管后接上人工鼻，A组将呼吸道压力峰值采样管放在人工鼻与麻醉机螺纹管之间，B组呼吸道压力峰值采样管放在气管导管与人工鼻之间，听诊确定气管导管位置；分别测量插管后即刻、0.5h、1h、1.5h、2h、2.5h、3h、3.5h、4h时患者气道峰压。结果： A组患者较B组在插管后0.5h、1h、1.5h、2h、2.5h几个时间点气道阻力峰值略有增加，差异无统计学意义（p0.05）；3.0h后两组患者气道压力峰值有统计学差异（p0.05）。结论：长时间使用人工鼻可以增加患者气道峰压，建议手术时间大于3.0h应更换人工鼻避免监测误差产生。 　　【关键词】 人工鼻 气道峰压 全身麻醉 手术时间 　　[Abstract] Objective To investigate the effect of long time mechanical ventilation on the peak inspiratory pressure of the two ends of the breathing filter. Methods One hundred patients ASAⅠorⅡunder general anesthesia， were randomly assigned into 2 groups （each=50）using a random number table： group A and group B. Connect breathing filter after tracheal intubation under general anesthesia， In group A， the peak airway pressure sampling tube was placed between the breathing filter and the anesthesia machine thread tube， In group B， the peak airway pressure sampling tube was placed between the breathing filter and the endotracheal tube， the correct position of endotracheal tube by auscultation； The airway peak pressure scale was measured separately after intubation immediately， 0.5h， 1h， 1.5h， 2h， 2.5h， 3h， 3.5h and 4h. Results Compared with group B the airway peak pressure scales of group A were slightly increased after intubation immediately， 0.5h， 1h， 1.5h， 2h， 2.5h， there was no significant differences between group A and group B （p 0.05）； After 3.0h the difference of the airway peak pressure scale between the two groups was significant（p0.05）. Conclusion Long time use of the breathing filter can increase the airway peak pressure， it is recommended that the operation time is greater than 3.0h should be replaced by breathing filter to avoid monitoring errors. 　　[key words] breathing filter； peak inspiratory pressure； general anesthesia； operation time 　　人工鼻又称呼吸过滤器、热湿交换器，是模拟人体解剖湿化和加热系统的机制所制造的人工替代装置。具有加温、加湿、生物滤过功能，在现代临床麻醉中广泛应用，是全身麻醉期间保护气道、降低呼吸回路微生物污染和控制院内感染的措施之一