老年阻塞型通气功能障碍患者CO_2气腹后肺顺应性改变及通气方式的选择  

Changes of pulmonary compliance and the selection of ventilation modes after CO_2 pneumoperitoneum in elderly patients with obstructive ventilatory dysfunction

作　　者：朱刚[1] 李立志[1] 王磊[1] 

机构地区：[1]上海市浦东新区人民医院麻醉科,201200

出　　处：《中国实用医药》2014年第23期12-14,共3页China Practical Medicine

摘　　要：目的探讨阻塞型通气功能障碍的老年患者CO2气腹后肺顺应性改变及通气方式的选择。方法阻塞型通气功能障碍的老年患者行腹腔镜手术60例,随机分为两组,组I(30例)设置呼吸频率(RR)10次/min、呼吸时比1:2.5;组II(30例)设置RR 16次/min、呼吸时比1:1.5。定容通气设置潮气量8 ml/kg,定压通气设置麻醉机通气压力使潮气量与定容通气一致。观察两组CO2气腹前和气腹后分别行定容通气及定压通气10 min后的气道压力(PPEAK、PPLAT)、潮气量、胸肺顺应性(C)、呼气末二氧化碳分压(PETCO2)。结果 I、II两组在气腹后PETCO2、PPEAK、PPLAT均明显高于气腹前(P<0.05),气腹后C均明显低于气腹前(P<0.05)。其中组I气腹后定压通气PPEAK、PPLAT均低于定容通气(P<0.05)。I、II组间比较,组II气腹后定容通气、定压通气PPEAK、PPLAT分别高于组I(P<0.05),PETCO2、C分别低于组I(P<0.05)。结论阻塞型通气功能障碍患者,二氧化碳气腹后,应选择压力调节容量控制(PRVC)通气模式或压力控制通气(PCV),同时随着手术时间延长,PETCO2升高,应增加呼吸频率,吸气时间不宜过短,以保证潮气量及不会过高的气道压力,呼吸时比以1:1.5为宜。Objective To investigate the changes of pulmonary compliance and the selection of ventilation modes after CO2 pneumoperitoneum in elderly patients with obstructive ventilatory dysfunction. Methods Divided 60 patients with obstructive ventilatory dysfunction receiving laparoscopic procedure into two groups. The data was set up as follows, in group I （30 cases）, RR was 10 times/min, and the ratio of inspiration to expiration was 1：2.5; while in group II（30 cases）, RR was 16 times/min, and the ratio of inspiration to expiration was 1：1.5. As for volume-controlled ventilation, tidal volume was 8 ml/kg, and as for pressure-controlled ventilation, the ventilation pressure of anesthesia machine was set up to make tidal volume the same with that of volume-controlled ventilation. The airway pressure （PPEAK, PPLAT）, tidal volume, pulmonary compliance（C）, and end-expiratory carbon dioxide partial pressure （PETCO2） were recorded after both volume-controlled ventilation and pressure-controlled ventilation for 10min, before and after CO2 pneumoperitoneum. Results In both group I and group II, the PETCO2, PPEAK and PPLAT after pneumoperitoneum were all significantly increased than that before pneumoperitoneum（P〈0.05）, and C after pneumoperitoneum was significantly decreased（P〈0.05）. In group I, after pneumoperitoneum, the PPEAK and PPLAT of pressure-controlled ventilation were obviously lower than that of volume-controlled ventilation （P〈0.05）. Compared to group I, the PPEAK and PPLAT of volume-controlled ventilation and pressure-controlled ventilation after pneumoperitoneum in group II were significantly higher（P〈0.05）; while PETCO2 and C were much lower（P〈0.05）.Conclusion In patients with obstructive ventilatory dysfunction, after CO2 pneumoperitoneum, pressure regulation volume control（PRVC） ventilation mode or pressure control ventilation（PCV） should be selected. At the same time, with the increasing of the operation time, PETCO2 is raised, and RR should be incre

关 键 词：阻塞型通气功能障碍 CO2气腹 定容通气 定压通气 

分 类 号：R614[医药卫生—麻醉学]