不同体质指数患者插管全麻期间呼吸参数的特点  

The characteristics of respiratory parameters in patients with different body mass index during general anesthesia with tracheal intubation

作　　者：梁青春 杨一梅 周芹[2] 李金河 靳三庆[3] LIANG Qingchun;YANG Yimei;ZHOU Qin;LI Jinhe;JIN Sanqing(Department of Anesthesiology,the Third Affiliated Hospital of Southern Medical University,Guangzhou 510630,China)

机构地区：[1]南方医科大学第三附属医院麻醉科,广州510630 [2]中山大学附属第一医院麻醉科,广州510080 [3]中山大学附属第六医院麻醉科,广州510000

出　　处：《实用医学杂志》2018年第9期1500-1503,共4页The Journal of Practical Medicine

基　　金：广东省医学科学研究基金资助项目(编号:A2003170)

摘　　要：目的探讨不同体质指数患者插管全麻期间呼吸参数的变化特点。方法 102例拟行中耳炎手术患者,分为体质量过低组32例(B_1),体质量正常组36例(B_2),超重或肥胖组34例(B_3),在全麻气管插管后,调整麻醉机潮气量,使患者呼气末二氧化碳分压维持在35~45 mm Hg之间,记录调整稳定后10min(T_1)、30 min(T_2)、60 min(T3)的动脉血气参数:动脉血pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(Pa CO2),以及呼吸参数:吸入潮气量(VTi)、呼出潮气量(VTe)、呼气末二氧化碳分压(PETCO2)、气道峰压(Ppeak)、气道平台压(Pplat)、肺动态顺应性(Cdyn)。结果 3组患者各时间点pH、PaO_2差异无统计学意义(P>0.05),B_3组的Pa CO2小于B1组和B2组(P<0.05)。与B2组相比,T1~T3各时间点,B_1组的VTi、VTe、Cdyn较大,B_3组的较小(P<0.05);B1组的Ppeak、Pplat较小,B_3组的较大(P<0.05);B1组的PETCO2较大(P>0.05),B_3组的较小(P<0.05)。结论随着体质指数的增加,插管全麻期间患者的潮气量、PETCO_2、PaCO_2、Cdyn逐渐下降,而气道压力逐渐增加,体质指数是插管全麻期间设定呼吸参数的参考指标。Objective To explore the characteristics of respiratory parameters in patients with differentbody mass index during general anesthesia with tracheal intubation. Methods 102 patients scheduled for otitis me-dia surgery were divided into low weight group（B1,n = 32）,normal weight group（B2,n = 36）and overweight orobese group（B3,n = 34）. After general anesthesia with tracheal intubation,the tidal volume of anesthetic ma-chine wasadjusted to maintain the end tidal carbon dioxide partial pressure between 35-45 mm Hg. At 10 min（T1）,30 min（T2）and 60 min（T3）after adjustment,arterial PH,arterial partial pressure of oxygen（PaO2）,arte-rial carbon dioxide pressure（Pa CO2）,inspiratory tidal volume（VTi）,expiratory tidal volume（VTe）,end tidalcarbon dioxide partial pressure（P（ET）CO2）,peak airway pressure（Ppeak）,plateau airway pressure（Pplat）and dy-namic lung compliance（Cdyn）were recorded. Results PH and PaO2 were not significantly different at T（1-3） amongthe three groups（P〉0.05）. As compared with group B1 and B2,PaCO2 was lower in group B3. In comparison withgroup B2,VTi,VTe and Cdyn were higher in group B1 and lower in group B3（P〈0.05）. Ppeak and Pplat werelower in group B1 but higher in group B3（P〈0.05）. PETCO2 was higher in group B1（P〉0.05）while lower in groupB3（P〈0.05）. Conclusions With the increase in BMI during general anesthesia with tracheal intubation,theVTi,VTe,Cdyn,PETCO2 and Pa CO2 decrease significantly,but Ppeak and Pplat elevate markedly. BMI is a refer-ence index for setting respiratory parameters.

关 键 词：体质指数 呼吸参数 全身麻醉 潮气量 

分 类 号：R614[医药卫生—麻醉学]