喉罩通气时潮气量对PaCO2与PETCO2差值的影响Theeffectsof.DOC

喉罩通气时潮气量对PaCO2与PETCO2差值的影响 The effects of ventilation with different tidal volume using LMA on the arterial-end tidal carbon dioxide gradient 张怡 姚俊岩 王慧娟 王赟 陈莲华 李士通* Author:Zhang yi,Yao junyan,Wang huijuan,Wang yun,Chen lianhua,Li shitong* 作者单位：200080 上海交通大学附属第一人民医院麻醉科 Author’s address: Department of Anesthesia, First People’s Hospital of Shanghai, Shanghai 200080, China. 通信作者：李士通，电子邮箱为lishitongs@ 【摘要】 目的：观察喉罩通气时潮气量（VT）对动脉血-呼气末二氧化碳分压差（Pa-ETCO2）的影响，探讨喉罩通气时呼气末二氧化碳分压（PETCO2）监测评估动脉血二氧化碳分压（PaCO2）的准确性。方法：选择符合纳入标准的择期骨科及普外科手术患者40例，全麻诱导后插入喉罩行机械通气，术中采用容量控制通气模式，随机安排先行常规潮气量（n=20）或先行小潮气量（n=20）通气，预设潮气量分别为9ml/kg或6ml/kg，调节呼吸频率使PETCO2稳定在35±2mmHg至少10分钟，血流动力学稳定后，采集动脉血行血气分析，监测PaCO2，同时记录PETCO2并计算Pa-ETCO2；继而将9ml/kg潮气量改为6ml/kg，或将6ml/kg潮气量改为9ml/kg，以同一方法监测及计算上述指标。结果：40例患者行9 ml/kg与6ml/kg潮气量通气时Pa-ETCO2分别为(6.5±4.8)mmHg和(6.4±4.1)mmHg，差异无统计学意义（P0.05）；两者变化范围分别为(0-16)mmHg和(0-14)mmHg。结论：喉罩行9ml/kg与6ml/kg潮气量通气时相比，Pa-ETCO2无明显变化，但其变化范围较大，PETCO2并不能完全准确地反映PaCO2 的变化。 【关键词】喉罩；潮气量；动脉血-呼气末二氧化碳分压差 【Key words】 laryngeal mask airway；tidal volume；arterial-end tidal carbon dioxide gradient 【Abstract】Objective: To observe the effects of ventilation with different tidal volume (VT) using laryngeal mask airway （LMA） on the arterial-end tidal carbon dioxide gradient (Pa-ETCO2) and to investigate the accuracy of estimating arterial carbon dioxide (PaCO2) from end tidal carbon dioxide(PETCO2). Methods：Forty patients, scheduled for orthopedics?operations or general surgery?operations met the inclusion criteria in this study. After the induction of general anesthesia, LMA was inserted. All patients received volume-controlled ventilation during anesthesia. Patients randomly?ventilated with conventional (n=20) or low (n=20) tidal volume (VT) first, the preset VT was 9ml/kg or 6ml/kg. PETCO2was controlled at 35±2 mmHg for at least 10 minutes by changing respiratory rate(RR)，when Hemodynamic was stable, Arterial blood was drawn for blood gas analysis, PaCO2 were monitored and Pa-ETCO2 was calculated. Then the VT of 9ml/kg wa