静吸复合全麻时机械通气与自主呼吸对鼓室成形术患者肺功能的影响  

Effects of mechanical ventilation and controlled spontaneous respiration on pulmonary function during short duration of general anesthesia with tracheal intubation

作　　者：蒋海[1] 靳三庆[1] 林世清[2] 蒋小朴[2] 陈锡辉[3] 

机构地区：[1]中山大学附属第六医院麻醉科,广东广州510655 [2]中山大学附属第一医院麻醉科,广东广州510080 [3]中山大学附属第一医院耳鼻喉科,广东广州510080

出　　处：《南方医科大学学报》2009年第11期2211-2214,共4页Journal of Southern Medical University

基　　金：广东省医学科学研究基金(A2003170)

摘　　要：目的探讨临床全麻中机械通气对肺功能的影响及保留自主呼吸的安全性和可行性。方法拟行单侧鼓室成形术患者53例,随机分为自主呼吸组(S组,25例)和控制呼吸组(M组,28例)。M组行快速诱导气管插管后予以机械通气,参数设定VT8ml/kg,RR10～12bpm,术中间断静脉滴注维库溴胺1～2mg维持肌肉松弛。S组慢诱导保留自主呼吸气管插管,术中不使用肌肉松弛药,保留自主呼吸。两组患者通过Datex气体监护仪调控术中麻醉气体(笑气复合异氟醚)MAC值1.2～1.3,必要时泵入丙泊酚(1～2)mg/(kg·h),控制BIS值40～60之间。记录两组患者各时间点的脉搏氧饱和度(SpO2),心率(HR),平均动脉压(MAP),胸腔体液含量(TFC),同时观察记录术中是否有呛咳,体动。两组患者均在气管插管后即时及150min抽取动脉血行血气分析得到pH值,PaO2,PaCO2,记录呼气末二氧化碳分压(PETCO2)并计算肺泡-动脉血氧分压差(P(A-a)DO2),呼吸指数(RI),生理死腔量与潮气量之比(VD/VT)。结果有10例患者因不同原因退出研究,共43例患者资料进入统计分析(M组n=23;S组n=20)。两组之间HR,MAP,TFC,P(A-a)DO2,RI,VD/VT,TFC的差异无统计学意义,组内不同时间点的P(A-a)DO2,RI,VD/VT差异也无统计学意义(P>0.05)。S组SpO2、pH值、PaO2低于M组,PaCO2,PETCO2高于M组(P<0.05),但均在正常范围或允许范围内。两组患者术中均未发生呛咳,体动。结论静吸复合全麻时,短时间的机械通气对无心肺功能障碍患者的肺气体交换功能无明显损伤作用;短时间的自主呼吸可提供充分的氧供,不引起危害性的二氧化碳潴留。Objective To evaluate the effects of mechanical ventilation on pulmonary function during short duration of general anesthesia with tracheal intubation,and assess the safety of controlled spontaneous respiration during general anesthesia.Methods Fifty-three adult patients（aged 18-55 years,ASA physical status Ⅰ-Ⅱ） scheduled for elective unilateral tympanoplasty were randomly assigned into mechanical ventilation group（group M,n=28） and spontaneous respiration group（group S,n=25）.Anesthesia induction was performed in group M with intravenous propofol（2 mg/kg）,fentanyl（3 μg/kg） and vecuronium（0.1 mg/kg）,while with propofol（2 mg/kg）,fentanyl（3 μg/kg） and sufficient superficial anesthesia on upper airway mucous membrane in group S.After tracheal intubation,mechanical ventilation began with VT 8 ml/kg and RR 10-12 bpm in group M,and spontaneous respiration was maintained in group S.Anesthesia was maintained by 0.7%-0.8% isoflurane and 60%-70% N2O at the end respiratory concentration to control MAC between 1.2-1.3.During the surgery,BIS values were controlled between 40-60,and propofol was administered when necessary.Vecuronium（1-2 mg） was given intermittently to maintain muscle relaxation and neostigmine（1 mg） with atropine 0.5 mg was administered intravenously before extubation in group M.No relaxant was used in group S.The parameters including heart rate（HR）,mean blood pressure（MAP）,pulse oxygen saturation（SpO2）,and thoracic fluid content（TFC） were recorded before the induction and at 1,5,10,20,40,60,90,120,and 150 min after intubation.Arterial blood was drawn immediately and 150 min after intubation for blood gases analysis and Alveolar-arterial oxygen gradient（P（A-a）DO2）,and the respiratory index（RI） and dead volume/tidal volume（VD/VT） were calculated.The incidences of moving,bucking,swallowing,and status of awareness during surgery procedures were also recorded.Results A total of 43 patients（group M,n=23;group S,n=20） were included in

关 键 词：机械通气 自主呼吸 肺功能 容许性高碳酸血症 

分 类 号：R614.2[医药卫生—麻醉学]