低潮气量机械通气对慢性肺病患者全麻术中肺呼吸的保护作用  

The efficacy of low tidal volume mechanical ventilation on pulmonary respiration protection of patients with chronic lung disease during general anesthesia

作　　者：魏智慧[1] 张海清[1] 韩田[1] 

机构地区：[1]河北省保定市第二中心医院麻醉科,河北保定072750

出　　处：《中国医药导报》2011年第31期104-106,共3页China Medical Herald

摘　　要：目的:观察低潮气量加低水平呼气末正压通气在慢性肺部疾病患者全麻手术中对肺呼吸功能的影响。方法:将慢性肺部疾病拟行非肺部手术患者100例,随机分为保护性通气组和常规通气组,每组各50例。保护性通气组(A组),通气模式采用低潮气量加低水平呼气末正压(PEEP)机械通气;常规通气组(B组),采用常规方法通气。分别于麻醉诱导前(T0)、机械通气1 h(T1)、拔管后15 min(T2)、术后6 h(T3)采动脉血行血气分析,并记录各时点的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、气道峰压(Ppeak)、气道平台压(Pplat)、平均动脉压(MAP)。结果:T1、T2、T3时A组PaO2水平高于B组,T1时A组Ppeak、Pplat低于B组,差异有统计学意义(P<0.05);两组各时点Pa-CO2、MAP比较,差异无统计学意义(P>0.05)。结论:慢性肺部疾病患者全麻手术中,低潮气量加低水平呼气末正压通气的肺保护性通气策略对肺的呼吸功能有保护作用。Objective： To observe the efficacy of low tidal volume plus low positive end expiratory pressure mechanical ventilation on respiratory function of patients with chronic lung disease during general anesthesia. Methods： 100 cases of patients with chronic lung disease who underwent non-lung surgery were randomly divided into protective ventilation group and conventional ventilation group, each of 50 cases. Low tidal volume ventilation plus low positive end expiratory pressure mechanicalventilation were adopted in protective ventilation group （group A）; conventional ventilation treatment was adopted in conventional ventilation group （group B）. Arterial blood gas analysis were conducted before induction of anesthesia （To）, 1 h after mechanical ventilation （T1）, 15 rain after extubation （T2）, 6 h after operation （T3） respectively, and PaO2, PaCO2, Ppeak, Pplat, MAP were recorded. Results： At the time of T1,T2 and %, PaO2 of group A was higher than that of group B （P〈0.05）, at the time of T,, Ppeak and Pplat of group A were lower than that of group B, the differences were statistically significant （P〈0.05）. PaCO2, MAP had no significant difference between the two groups at each time （P〉0.05）. Conclusion： Low tidal volume plus low positive end expiratory pressure mechanical ventilation have protective effects on lung respiratory function of patients with chronic lung disease during general anesthesia.

关 键 词：低潮气量 呼气末正压 全身麻醉 慢性肺部疾病 呼吸功能 

分 类 号：R563.8[医药卫生—呼吸系统]