肥胖对胆囊切除术患者围术期肺功能的影响  

Effects of obesity on pulmonary function in patients during and after cholecystectomy

作　　者：李明川 白宇 王俊科 

机构地区：[1]中医医科大学附属第一医院麻醉科,沈阳市110001

出　　处：《中华麻醉学杂志》2005年第5期334-337,共4页Chinese Journal of Anesthesiology

摘　　要：目的研究肥胖对胆囊切除术患者围术期肺功能的影响。方法择期行胆囊切除术患者20例,体重指数(BMI)<25者10例,为正常体重组;BMI>30者10例,为肥胖组。所有患者均采用全凭静脉麻醉,控制呼吸,潮气量设为10ml·kg-1,控制呼气末二氧化碳分压(PETCO2)在35-40mmHg之间,吸呼比为1:2,吸氧浓度为100%。分别于术前、麻醉诱导后15min、手术开始后30min、术后6、24h测定pH值、动脉血氧分压(PaO2)、动脉血气二氧化碳分压(PaCO2)、肺泡-动脉氧分压差[D(A-a)O2]、肺功能残气量(FRC),并于术前、术后6、12h时测定用力肺活量(FVC)、一秒用力呼气容量(FEV1.0)、最大呼气中段流量(MMF)。结果与术前比较,两组FRC在麻醉诱导后至术后24h时均下降,在术后6,24h时PaO2均下降,D(A-a)O2增高(P<0.01);与麻醉诱导后15min比较,正常体重组FRC在术后6,24h时升高(P<0.01)。与正常体重组比较,肥胖组在麻醉诱导后至术后24h时FRC及PaO2、D(A-a)O2的变化率降低,术后6,24h时FVC、FEV1.0、MMF降低(P<0.01)。结论肥胖患者FRC和通气功能的降低比正常体重患者大。Objective To investigate the effects of obesity on functional residual capacity ( FRC ) , ventilatory function and gas exchange during and after cholecystectomy. Methods Twenty ASA Ⅰ or Ⅱ patients of both sex aged 26-58yr undergoing elective cholecystectomy were divided into 2 groups according to the body mass index (BMI): control group BMI < 25 ( n = 10) and obesity group BMI > 30 (n = 10) . The patients were premedicated with intramuscular luminal 1.0 g and atropine 0.5 mg. Anesthesia was induced with midazolam 2-3 mg, fentanyl 5μg·*kg-1, propofol 1.5-2.0 mg·kg and vecuronium 0.1 mg·kg-1 and maintained with infusion of propofol (at 8-10 mg·kg-1·h-1) and fentanyl (at 1-2 μg·kg-1·h-1) and intermittent i.v. boluses of vecuronium after tracheal intubation. The patients were mechanically ventilated (VT 10ml·kg-1,I:E=1:2, FiO2 100%) and PETCO2 was maintained at 35-40 mm Hg by adjusting the respiratory rate. Pethidine 1 mg·kg-1 was given i.m. every 8 h after operation for analgesia. BP, HR, ECG, SpO2, PET CO2 , FiO2, VT , RR were monitored during anesthesia. Arterial blood samples were taken before anesthesia (T0, baseline), 15 min after induction of anesthesia (T1), 30 min after skin incision (T2) and 6, 24 h after operation (T3,4) for blood gas analysis. FRC (closed-circuit helium dilution method), forced vital capacity (FVC), forced expiratory volume at 1 second (FEV10) and maximal mid-expiratory flow volume (MMF) were measured before and 6 h and 24 h after operation.Results FRC was significantly decreased after induction of anesthesia, during and after operation compared with the baseline value (T0) in both groups and the decrease in FRC was significantly larger in obesity group than in control group (P < 0.01). PaO2 was significantly decreased and D(A-a)O2 was significantly increased at 6 h and 24 h after operation compared to the baseline values (T0) in both groups. The decrease in PaO2 and increase in D(A-a) O2 were significantly larger in obesity group than in control group. FVC, FEV1.0 and MMF

关 键 词：胆囊切除术 围术期 呼气末二氧化碳分压 麻醉诱导 全凭静脉麻醉 动脉血氧分压 肺功能残气量 呼气中段流量 FEV1.0 24h 用力肺活量 FRC 体重指数 控制呼吸 10ml 吸氧浓度 动脉血气 用力呼气 PAO2 正常体重 通气功能 肥胖患者 

分 类 号：R614[医药卫生—麻醉学]