围术期移动CT监测不同潮气量通气对肺不张的影响  

Effect of different tidal volume ventilations on atelectasis in patients during general anesthesia by CT scan

作　　者：龚华[1] 张丽娜[1] 蔡宏伟[1] 王延金[2] 侯永宏[2] 

机构地区：[1]中南大学湘雅医院麻醉科,长沙410008 [2]中南大学湘雅医院神经外科,长沙410008

出　　处：《中南大学学报（医学版）》2007年第5期850-854,共5页Journal of Central South University ：Medical Science

基　　金：湖南省卫生厅科研课题(B2004-023)~~

摘　　要：目的:研究不同潮气量通气对全麻病人肺不张的影响。方法:20例20～50岁颅内病损切除术患者,随机分为2组(n=10):常规潮气量组(TV,潮气量10mL/kg);小潮气量组(LV,潮气量6mL/kg)。分别于麻醉前、麻醉诱导插管后10min、手术结束后10min利用移动CT行全肺扫描,观察膈上1cm层面肺不张面积和百分比的变化并行动脉血气分析;观察插管后30,120,240min的呼吸力学指标的变化。结果:与麻醉前比较,两组患者麻醉诱导插管后10min、手术结束后10min肺不张的面积和百分比明显增加(P<0.05);两组患者肺不张的面积和百分比及血气指标[(P(A-a)O2,PaCO2,PaO2/FiO2,Ri]在麻醉诱导插管后10min、手术结束后10min组内组间差异均无统计学意义(P>0.05);术中TV组Ppeak,Pplat,Pmean,Cst均显著高于LV组(P<0.05)。结论:低潮气量通气(潮气量6mL/kg)不增加肺不张,对换气功能的影响较小,可能是全麻机械通气更适宜的通气方式。Objective To investigate the effect of different tidal volume ventilations on the a- mount of atelectasis during general anesthesia. Methods Twenty adults, ASA physical status I and status II patients, who were scheduled for elective excision of intracranial lesion were randomly divided into 2 groups ： Group TV （ traditional tidal volume ventilation, 10 mL/kg ） and Group LV （ low tidal volume ventilation, 6 mL/kg）. Atelectasis, as determined by CT and artery blood gas （ABG） analysis, was measured before the anesthesia, after the tracheal intubation, and at the end of the op- eration, respectively. Respiratory mechanical parameters were measured at 30, 120, and 240 min after the intubation. Results After the tracheal intubation, CT scan showed obvious atelectasis in both groups. The atelectasis area was（4. 35 _＋2. 15）cm2 （3. 12% _＋ 1.94% ） in the TV group and （4.80 _＋2.45 ）cm2（ 3.89% _＋2. 11% ） in the LV group, with a nonsignificant difference be- tween the 2 groups. At the end of the operation, there was no significant increase in the amount of atelectasis between and within the 2 groups. Artery blood gas analysis showed no difference after thetracheal intubation and at the end of the operation in either group. Ppeak, Pplat, Pmean and lung compliance （Cst）were significantly higher in the TV group than those in the LV group. Conclusion Low tidal volume （6 mL/kg ） ventilation is more feasible during general anesthesia in patients with healthy lungs, and it does not increase the atelectasis and impairment of gas exchange.

关 键 词：全麻 潮气量 肺不张 电子计算机体层摄影 

分 类 号：R614.2[医药卫生—麻醉学]