不同潮气量对老年高血压患者行腹腔镜胆囊切除术循环及呼吸参数的影响  

Effect of different tidal volume on the hemodynamic status and respiratory parameters of laparoscopic cholecystectomy in elderly patients with hypertension

作　　者：范建军 陈彪[2] FAN Jianjun;CHEN Biao(School of Graduate,Baotou Medical College of Inner Mongolia University of Science and Technology,Baotou 014040,China;The First Affiliated Hospital of Baotou Medical College,Baotou 014010)

机构地区：[1]内蒙古科技大学包头医学院 [2]内蒙古科技大学包头医学院第一附属医院

出　　处：《包头医学院学报》2018年第5期57-59,共3页Journal of Baotou Medical College

摘　　要：目的:探讨不同潮气量对老年高血压患者行腹腔镜下胆囊切除术循环及血气参数的影响。方法:全麻下择期行腹腔镜下胆囊切除术老年高血压患者60例,随机均分为两组:潮气量6 m L/kg(D组),潮气量10 m L/kg(G组)。术前均给予咪达唑仑1 mg,2 min后测量心率(heart rate,HR)、平均动脉压(mean artery pressure,MAP)以及血氧饱和度(SpO_2)。常规麻醉诱导后气管插管,行容量控制模式通气,D组潮气量设置为6 m L/kg,G组潮气量设置为10 m L/kg。记录入室时(T0)、给予咪达唑仑2 min(T_1)、气腹前(T_2)、气腹10 min(T_3)、20 min(T_4)、30 min(T_5)的MAP、HR及气腹前(X_1)、气腹30 min(X_2)动脉血气分析。实验过程中若出现心率、血压明显下降或者恶性心律失常,则立即结束实验。结果:与D组比较,G组T_3、T_4、T_5时HR升高、MAP降低(P<0.05);且D组T_3-T_5间HR、MAP水平波动较稳定。与D组比较,G组X_2时pH升高、二氧化碳分压(PaCO_2)降低(P<0.05)。结论:低潮气量机械通气可减少老年高血压患者行腹腔镜胆囊切除术循环及血气参数波动,可维持循环及呼吸稳定。Objective： To evaluate the effects of different tidal volume on the hemodynamic status and respiratory parameters of laparoscopic cholecystectomy in elderly patients with hypertension. Methods： sixty elderly patients with hypertension undergoing elective laparoscopic cholecystectomy surgery under general anesthesia,were randomly divided into two groups,including group D and group G. The patients were given midazolam 1 mg before operation and HR,MAP and SpO2 were monitored after 2 minutes. The routine anesthesia induced the tracheal intubation and the capacity control mode ventilation. Group D had a tidal volume of 6 ml/kg,and group G had a tidal volume of 10 ml/kg. Mean arterial pressure（ MAP） and heart rate（ HR） were recorded at the time in the operating room（ T0）,two minutes after midazolam was given（ T1）,before pneumoperitoneum was established（ T2）,and 10 minutes（ T3）,20 minutes（ T4） and 30 minutes（ T5） after pneumoperitoneum was established. Arterial blood gas analysis was recorded at the time before pneumoperitoneum was established and 30 minutes after pneumoperitoneum was established.Results： During T3-T5,HR in group G was higher than group D and MAP in group G was lower than group D（ P〈0. 05）. The level fluctuations of HR and MAP in group D were relatively stable. During X2,PH and PaCO2 in group G was higher and lower respectively than those of group D（ P〈0. 05）. Conclusion： Small tidal volume mechanical ventilation can reduce the hemodynamic status and respiratory parameters fluctuation of laparoscopic cholecystectomy in elderly patients with hypertension,maintaining hemodynamics and respiratory stability.

关 键 词：潮气量 老年高血压 腹腔镜 循环 呼吸参数 

分 类 号：R614[医药卫生—麻醉学]