全麻下不同通气模式对气管内异物行纤维支气管镜手术患儿的影响  

The effects of different modes of mechanical ventilation under general anesthesia on children undergoing removal of foreign body with bronchofiberscopy

作　　者：范开明[1] 万震威[1] 李长科[1] 杨印楼[1] 陈斌[1] 

机构地区：[1]韶关市粤北人民医院麻醉科,广东省韶关512026

出　　处：《中国医师杂志》2015年第7期1009-1012,共4页Journal of Chinese Physician

基　　金：基金项目：2013年韶关市医药卫生科研计划资助项目（Y13155）

摘　　要：目的 探讨全麻下不同通气模式对气管内异物行纤维支气管镜手术患儿的影响.方法 选择60例1～3岁需行纤维支气管镜检气管内异物取出术的患儿,按随机数字表法分为A组[操作中行容量控制通气（VCV）,操作后行VCV,n=20]、B组[操作中行压力控制通气（PCV）,操作后行VCV,n=20]和C组（操作中行PCV,操作后行PCV,n=20）,监测三组患儿操作中与操作后的平均气道压（P mean）、气道峰压（P max）和呼气末二氧化碳分压（PetCO2）及机械通气后1.5h的动脉氧饱和度（SpO2）、血氧分压（PaO2）、血二氧化碳分压（PaCO2）等指标.结果 纤维支气管镜操作过程中,B组与C组的平均气道压（P mean）、气道峰压（P max）和呼气末二氧化碳分压（PetCO2）明显低于A组（P＜0.05）;操作后,C组的平均气道压（P mean）、气道峰压（P max）和呼气末二氧化碳分压（PetCO2）明显低于A、B组（P＜0.05）;术后1.5h与操作前比较,三组患者的脉搏氧饱和度（SpO2）、血氧分压（PaO2）均显著提高,血二氧化碳分压（PaCO2）均明显降低（P＜0.05）.结论 患儿在全麻下行纤支镜异物取出术中,选择PCV的通气模式比VCV更有利于降低术中气道压和二氧化碳分压.Objective To explore the effects of different ventilation modes of tracheobronchial foreign body in children with fiberoptic operation under general anesthesia.Methods Sixty children （1ys≤ age≤3ys） undergoing fiberoptic bronchoscopy tracheal foreign body removal according to the combinations of different ventilation modes during and after fiberoptic bronchoscopy （FOB） procedures were divided into group A [volume control ventilation （VCV） ＋ VCV,n =20],group B [pressure control ventilation （PCV） ＋ VCV,n =20] and group C （PCV ＋ PCV,n =20） randomly.The P mean,Pmax,and PetCO2 during and after fiberoptic bronchoscopy procedures were monitored.The SpO2,PaO2,and PaCO2 after mechanical ventilation 1.5 hours were recorded.Results Compared to group A,groups B and C had lower P max and P mean （P 〈 0.05） during the FOB procedures.Compared to groups A and B,group C had a lower P max and P mean （P 〈0.01） after the FOB procedures.At the 1.5 hours after the procedure,all the children showed significant increase in SpO2 and PaO2 （P 〈 0.05） and decrease in PaCO2 （P 〈 0.05） in groups A,B,and C.Conclusions When fiberoptic bronchoscopy in tracheobronchial foreign body operation is applied in children undergoing general anesthesia,the pressure control ventilation （VCV） mode can decrease the pressure of airway （Paw） and PaCO2 than volume control mode during procedure.

关 键 词：麻醉 全身 呼吸 人工 支气管镜检查 异物/外科学 气管疾病/外科学 

分 类 号：R726.1[医药卫生—儿科]