心脏手术患者在小潮气量机械通气时使用经食道多普勒心排量监测的临床观察  

Impact of mechenical ventilation with small tidal volume on heart function in cardiac surgery patients

作　　者：褚淑娟[1] 吴志林[1] 伍静[1] 姚尚龙[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院麻醉科,武汉430022

出　　处：《临床急诊杂志》2015年第9期687-689,共3页Journal of Clinical Emergency

摘　　要：目的：探讨采用不同潮气量机械通气对心脏手术患者心排量的影响。方法：将40例ASAⅡ~Ⅲ级择期心脏手术患者随机分为常规潮气量组（10ml/kg）、小潮气量组（6ml/kg）,呼吸频率固定于12次/min,呼气末正压通气（PEEP）均设定在5cmH2O（1cmH2O=0.098kPa）水平。记录患者全身麻醉气管插管后机械通气开始及机械通气30min时的气道压力指标、血流动力学指标,采用经食道多普勒监测患者心排量,血气分析计算氧合指数。结果：小潮气量组较常规潮气量组患者平均气道压和气道峰压明显降低,2组患者的心率、平均动脉压、中心静脉压、氧合指数、心排量指数均无显著差异。结论：采用小潮气量可以降低机械通气时的气道压力,减少气压伤的风险,降低外周血管阻力,因此值得在临床应用中推广。Objective：To observe the impact of mechanical ventilation with different tidal volume on heart function in cardiac surgery patients.Method：Forty cases of selective cardiac surgery patients of ASA Ⅱ~Ⅲ were randomly allocated into two groups：routine tidal volume group and small tidal volume group.Patients in routine tidal volume group were given a tidal volume of 10 ml/kg and patients in small tidal volume group were given a tidal volume of 6ml/kg.Respiration rate was set at 12 bpm and PEEP was set at 5cmH2 O.Oesophageal Doppler monitoring was implemented.Airway pressure,hemodynamic indices and heart function indices were recorded at time points of beginning of mechanical ventilation and 30 minutes after intubation.Oxygenation index was calculated according to results of blood gas analysis.Result：Peripheral vessel resistance indices and airway pressure were significant lower in small tidal volume group than routine tidal volume group.No difference for indices as HR,MAP,Expiration CO2 pressure,oxygenation index and CI between the two groups.Conclusion：Small tidal volume mechanical ventilation,which produces a lower airway pressure and lower peripheral vessel resistance than routine tidal volume,can decrease the risk of pulmonary barotraumas and is worthy of widely clinical implementation.

关 键 词：小潮气量 机械通气 心功能监测 

分 类 号：R614[医药卫生—麻醉学]