呼气末正压通气对不同体质量指数阻塞性睡眠呼吸暂停患者全麻术中呼吸功能的影响  

Effects of positive end-expiratory pressure on respiratory function of the patients of obstructive sleep apnea with different body mass index during general anesthesia

作　　者：刘炜炜[1] 裴凌[1] 

机构地区：[1]中国医科大学附属第一医院麻醉科,沈阳110001

出　　处：《中国医师杂志》2013年第12期1585-1588,共4页Journal of Chinese Physician

基　　金：国家自然科学基金（81071530/H1502）

摘　　要：目的分析呼气末正压（PEEP）通气对不同体质量指数（BMI）阻塞性睡眠呼吸暂停（OSA）患者全麻术中呼吸功能的影响。方法观察组：择期行悬雍垂腭咽成形术的OSA患者40例，按照BMI将患者分为2组（n=20）：A组，26ks／m2〈BMI〈30ks／m2；B组，BMI〉32ks／m2。对照组（C组）：择期行鼓室成形术患者20例，BMI〈24kg／m2。所有病例性别不限，年龄20—57岁，ASAⅠ或Ⅱ级。麻醉诱导前面罩吸入纯氧10min。常规诱导，经口气管插管，机械通气。3组病例均在诱导后先后使用0cmH2OPEEP和8cmH2OPEEP各通气60min。监测动态呼出末二氧化碳（PETCO2）、气道峰压（P础）、胸肺顺应性（Crs）、气道阻力（Rsw）和动态压力一容积（P-V）曲线。分别于诱导后5min（T1）、60min（T2）、120min（T3）记录PETCO2、CrsRsw，观察P—V曲线变化。于清醒状态未吸氧前（T0）、T1-T3采集动脉血样行血气分析。计算氧合指数（PaO2／FiO2）、呼吸指数（RI）和生理无效腔（VD／VT）。结果与T0时比较，B组于T1和T2时PaO2／Fi02下降，RI升高（P〈0．05）。与T1时比较，B组于T3时PaO2／FiO2、Crs升高，RI下降（P〈0．05）。与C组比较，B组于T1和T2时PaO2／FiO2和Crs降低（P〈0．05）；于T1—T3时Rsw、RI、VD／VT升高（P〈0．05）。术中及术后24h，3组病例血流动力学稳定，无不良反应发生。结论全麻状态下，OSA肥胖患者会出现更严重的呼吸功能改变，术中应用PEEP有助于改善气体交换和呼吸力学指标，对血流动力学无明显影响。Objective To analyze the effects of positive end-expiratory pressure （PEEP） on respiratory function of the patients of obstructive sleep apnea （OSA） with different body mass index during general anesthesia. Methods Forty patients undergoing elective uvulopalatopharyngoplasty were divided into two body weight groups （ n = 20 each） ; group A overweight patiens （26 kg/m2 〈 BMI 〈 30 kg/m2） and group B obese patients （ BMI 〉 32 kg/m2 ）. Control group ： twenty patients with BMI 〈 24 kg/m2 scheduled for elective tympanoplasty. All the patients were of ASA grade I or II, aged 20 - 57 years. Before induction of anesthesia, preoxygenation was given during 10 min by using 100% 02 with a seal mask. After induction of anesthesia as usual, the patients were intubated with an orotracheal tube and mechanically ventilated. All patients of three groups were applied 0 cmH20 PEEP and then 8 cmH20 PEEP, and maintained for 60 min each. During the procedure, end-tidal carbon dioxide pressure （PET CO2 ）, peak airway pressure （Ppeak） , compliance of respiratory system （ Crs ） , airway resistance （ Raw ） , and dynamic pressure-volume （P-V） curves were monitored. Measurements of PETCO2, Crs and Raw were recorded, obtained at 5 min after induction and tracheal intubation （To）, 60min （T1 ）, and 120min （T2 ）. At the time of awake breathing ambient air （To ） and T1- T3, arterial blood samples were taken, and blood gas analysis was performed. Oxygenation index （PaO2/FiO2 ）, respiratory index （RI）, and physiologic dead space fraction （ VD/VT ） were calculated. Results PEEP 8 cmH2O significantly increased PaOJFiO2, Crs and decreased RI at T3 as compared with those at T1 in group B but there was no significant change in PaO2/FiO2, Crs and RI when PEEP 8 cmH20 was applied at T3 as compared with those at T1 in group A or group C. No adverse reaction occurred in the three groups. Conclusions In obese patients with OSA, general anesthesia lead to more severe alterations in r

关 键 词：正压呼吸 人体质量指数 睡眠呼吸暂停 阻塞性 外科学 麻醉 全身 呼吸 

分 类 号：R614[医药卫生—麻醉学]