喉罩通气时潮气量对动脉血二氧化碳分压和动脉血呼气末二氧化碳分压差值的影响  

Effects of ventilation with different tidal volumes on arterial partial pressure of carbon dioxide and arterial-end tidal carbon dioxide gradient during laryngeal mask airway

作　　者：张怡[1] 姚俊岩[1] 王慧娟[1] 王赟[1] 陈莲华[1] 李士通[1] 

机构地区：[1]上海交通大学附属第一人民医院麻醉科,上海200080

出　　处：《上海医学》2014年第8期666-668,共3页Shanghai Medical Journal

摘　　要：目的观察喉罩通气时潮气量（VT）对动脉血呼气末二氧化碳分压差的影响，探讨喉罩通气时呼气末二氧化碳分压（PetCO2）监测评估动脉血二氧化碳分压（PaCO2）的准确性。方法选择符合纳入标准的择期骨科和普外科手术患者40例，全身麻醉诱导后插入喉罩行机械通气，术中采用容量控制通气模式，随机安排先行常规潮气量（常规潮气量组，20例）或先行小潮气量（小潮气量组，20例）通气，预设潮气量分别为9mL／kg或6mL／kg，调节呼吸频率使PetCO2（35±2）mmHg（1mmHg=0．133kPa）至少10min，采集动脉血（第1次采集）行血气分析，监测PaC02，同时记录PetCO2并计算动脉血呼气末二氧化碳分压差；继而将潮气量由9mL／kg改为6mL／kg，或将潮气量由6mL／kg改为9mL／kg，以同一方法（第2次采集动脉血）监测并计算上述指标。结果常规潮气量组动脉血呼气末二氧化碳分压差变化范围在0～16mmHg，平均动脉血呼气末二氧化碳分压差为（6．5±4．8）mmHg；小潮气量组患者的动脉血呼气末二氧化碳分压差变化范围在O～14mmHg，平均动脉血呼气末二氧化碳分压差为（6．4±4．1）mmHg。两组间动脉血呼气末二氧化碳分压差的差异无统计学意义（P〉0．05）。结论喉罩行9mL／kg与6mL／kg潮气量通气相比，动脉血呼气末二氧化碳分压差无明显变化，但两组患者动脉血呼气末二氧化碳分压差变化范围较大，PetCO2并不能完全准确地反映PaCO2的变化。Objective To observe the effect of ventilation with different tidal volumes （VT） on the arterial-end tidal carbon dioxide gradient （Pa-ETCO2） and to investigate the accuracy of estimating arterial partial pressure of carbon dioxide （paCO2） according to end tidal carbon dioxide （PetCO2） when laryngeal mask airway （LMA） is applied. Methods Forty patients, scheduled for orthopedic operations or general surgical operations, met the inclusion criteria and were enrolled in this study. After the induction of general anesthesia, LMA was inserted. All patients received volume-controlled ventilation during anesthesia. Patients were randomly ventilated with conventional （n = 20） and low （n = 20） VT first, and the preset VT was 9 mL/kg and 6 mL/kg, respectively. PetCO2was controlled at （35±2） mmHg （1 mmHg= 0. 133 kPa） for at least 10 minutes by changing respiratory rate （RR）. When hemodynamics was stable, arterial blood sample was collected for blood gas analysis, paCO2 was monitored and Pa-ETCO2 was calculated. Then the VT of 9 mL/kg was changed into 6 mL/kg and the VT of 6 mL/kg was changed into 9 mL/kg; the above indices were monitored and calculated in the same way. Results There was no significant difference in Pa-ETCO2 between ventilation with 9 mL/kg VT （[-6.5±4.8] mmHg, 0- 16 mrnHg） and 6 mL/kg VT （[6.4±4.11 mmHg, 0- 14 mmHg, P〉0.05）. Conclusion There is no significant difference in Pa-ETCO2 between ventilation with 9 mL/kg and 6 mL/kg when LMA is performed. But Pa-ETCO2 variation range is wide and petCO2 cannot completely reflect the change of paCO2. （Shanghai Med J, 2014, 37： 666-668）

关 键 词：喉罩 潮气量 动脉血呼气末二氧化碳分压差 

分 类 号：R614[医药卫生—麻醉学]