行高频通气患者发生CO_2蓄积的危险因素及其与体质指数的关系  

Risk factors of CO_2 retention during high-frequency jet ventilation and its relationship with body mass index

作　　者：谭放[1] 李绍清[1] 陈莲华[1] 缪长虹[2] 

机构地区：[1]复旦大学附属眼耳鼻喉科医院麻醉科,上海200031 [2]复旦大学附属中山医院麻醉科,上海200032

出　　处：《复旦学报（医学版）》2010年第6期637-641,共5页Fudan University Journal of Medical Sciences

摘　　要：目的探讨行高频通气（high-frequency jet ventilation,HFJV）患者围术期发生CO2蓄积的可能因素,分析CO2蓄积与体重指数的关系。方法择期行支撑喉镜下手术患者59例,ASAⅠ或Ⅱ级,所有患者经鼻插入喷射管至气管内与喷射通气呼吸机相接行HFJV,通气频率为60次/min,压力约2 kPa/kg,吸呼时间比为1∶（2.0~2.5）。所有患者均以芬太尼、丙泊酚和琥珀胆碱静脉注射诱导麻醉,术中间断追加丙泊酚及琥珀胆碱维持麻醉。记录患者围术期相关情况,分别于麻醉前（T0）、气管插管时（T1）、放置支撑喉镜时（T2）、通气10 min时（T3）、拔管时（T4）及术毕10 min时（T5）监测并记录心率（heart rate,HR）、平均动脉压（mean artery pressure,MAP）、脉搏血氧饱和度（SpO2）及血气分析等。结果 Logistic回归分析显示,性别、体重和身高与CO2蓄积的发生有关,女性较之男性出现CO2蓄积的风险更低,前者约为后者的7%;身高每增加1 cm,CO2蓄积风险降低为原来的77%;体重每增加1 kg,风险上升到原来的116%。出现CO2蓄积人群的体质指数（body mass index,BMI）高于未出现CO2蓄积人群,大于25.224的患者易发生CO2蓄积。结论 BMI的增加是行HFJV患者发生CO2蓄积的相关危险因素。Objective To investigate the perioperative risk factors for CO2 retention during high-frequency jet ventilation（HFJV） in patients undergoing suspension laryngoscopic surgery,and to analyze the relationship between CO2 retention and body mass index（BMI）.Methods Fifty-nine patients with ASA Ⅰ or Ⅱ undergoing suspension laryngoscopic surgery were inserted transnasally with a jet catheter modified from a suction tube,and the head of jet catheter was connected to the machine of HFJV.Jet ventilation was executed with the frequency of 60 beats per min,the pressure of 2 kPa/kg and I∶E=1∶（2.0-2.5）.Anesthesia was induced by fentanyl,propofol and succinylcholine,and was maintained by intermittent injection of propofol and succinylcholine.Heart rate（HR）,mean artery pressure（MAP）,SpO2 and blood gas analysis were recorded at a series of time points including the timepoint before anesthesia（T0）,during the intubation（T1）,laryngoscope suspending（T2）,10 min after the beginning of jet ventilation（T3）,during the extubation（T4） and 10 min after the extubation（T5）.Perioperative medication and other relative conditions were also recorded.Results It was identified that sex,body weight and height strongly correlated with CO2 retention during operation in adults by Logistic regression analysis.The risk of CO2 retention decreased significantly in females compared with males,and the former was as 7% as the later.As height increased by 1 cm,the risk of CO2 retention reduced to 77%,while as body weight increased by 1 kg,the risk of CO2 retention increased to 116%.The BMI of population with CO2 retention was higher than that without CO2 retention.The BMI over 25.224 could be considered as the most important risk factor correlated to the occurrence of CO2 retention.Conclusions The higher BMI could be regarded as the risk factor of CO2 retention during HFJV in adults.

关 键 词：高频通气 CO2蓄积 危险因素 体质指数 围术期 

分 类 号：R614.24[医药卫生—麻醉学]