全麻下不同潮气量机械通气时呼吸功能变化的临床研究  

Effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia

作　　者：焦赫娜[1] 蔡宏伟[1] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008

出　　处：《中南大学学报（医学版）》2007年第4期706-709,共4页Journal of Central South University ：Medical Science

摘　　要：目的:研究全麻下不同潮气量正压机械通气时呼吸功能的变化,探讨麻醉时机械通气较为理想的潮气量。方法:40例ASAⅠ～Ⅱ级的颅脑手术患者,均取仰卧位,根据三因素四水平拉丁方设计,将40例患者先后使用4,6,8,10mL/kg四种不同潮气量施行持续正压机械通气各30min,呼吸频率固定为15次/min,监测不同潮气量机械通气时肺顺应性、循环及血气各指标的变化。结果:随着潮气量的增加,肺泡动脉血氧分压差(A-aDO2),动脉血与呼吸末二氧化碳分压差(Pa-ETCO2),气道峰压(PPEAK),平均气道压(PMEAN),平台压(PPLAT),动态肺顺应性(CDYN),静态肺顺应性(CSTAT)均逐渐增加,各潮气量组间比较差异有统计学意义(P<0.05);随着潮气量的增加,ETCO2,PaCO2逐渐降低,各潮气量组间比较差异有统计学意义(P<0.05);而各潮气量组间PaO2,SPO2,MAP,HR的比较差异无统计学意义(P>0.05)。结论:心肺功能正常患者全麻仰卧位机械通气频率为15次/min时,4mL/kg潮气量组(分钟通气量60mL/kg)氧合最好,但不能充分排出CO2而对改善肺通气功能不利;潮气量6～8mL/kg适用于神经外科手术患者;单纯增大潮气量并不能明显改善麻醉所致的肺通气功能障碍。Objective To determine the effect of mechanical ventilation with different tidal volumes on the respiratory function during general anesthesia and to seek optimum way and parameters of mechanical ventilation during general anesthesia. Methods Forty ASAⅠ～Ⅱ patients scheduled for elective craniotomies in the supine position were included in this study. According to latin square design, the patients were randomly divided into 4 groups. Every group has its own tidal volume sequence. Each patient used 4 tidal volumes in turn. Every tidal volume maintained 30 minutes. The rate of mechanical ventilation was 15. But ECG, blood pressure, heart rate, SPO2, ETCO2, airway pressure, lung compliance, and blood gas analysis were continuously monitored. Results A-aDO2 , Pa-ETCO2 , PPEAK , PMEAN , PPLAT , CDYN , and CSTAT significantly increased as the tidal volume increased （P 〈 0.05 ）. But ETCO2 and PaCO2 decreased as the tidal volume increased （P 〈 0.05 ）. PaO2, SPO2 , MAP and HR had no significant difference between the 4 tidal volume groups （ P 〉 0.05 ） . Conclusion The optimum tidal volume of mechanical ventilation is not 4 mL/kg at the rate of 15 respiratory rate during general anesthesia in the supine position because of a high arterial carbon dioxide tension. Yet 6 - 8 mL/kg is better for neurosurgical anesthesia. Increasing the tidal volume alone may not improve the respiratory function impairment during general anesthesia.

关 键 词：全身麻醉 机械通气 潮气量 呼吸功能 

分 类 号：R614.2[医药卫生—麻醉学]