Trendelenburg体位和呼气末正压对喉罩全身麻醉患者颈内静脉横截面积的影响  

Effect of trendelenburg position and positive end-expiratory pressure on the cross-sectional area of internal jugular vein in general anesthesia of laryngeal mask airway

作　　者：傅丹霞 卢波[2] 陈骏萍[2] FU Danxia;LU Bo;CHEN Junping(Ningbo NO.2 Hospital,Ningbo 315010,Zhejiang,China)

机构地区：[1]宁波大学医学院,宁波315211 [2]宁波市第二医院

出　　处：《现代实用医学》2018年第2期148-149,172,共3页Modern Practical Medicine

基　　金：浙江省医药卫生科技计划项目(2014KYB235;2017KY591;2017KY137);宁波市自然科学基金项目(2016A610144)

摘　　要：目的探讨呼气末正压(PEEP)、Trendelenburg体位及两者联合应用对喉罩全身麻醉患者颈内静脉横截面积(CSA)的影响。方法择期喉罩全身麻醉患者60例,随机分为4组:PEEP 0 cm H_2O(1 cm H_2O≈98 Pa,P0组)、Trendelenburg体位(T组)、PEEP 10 cm H_2O(P10组)和Trendelenburg体位联合PEEP 10 cm H_2O(C组)。患者先后于4个分组方案下接受右侧颈部超声检查,记录各个分组的颈内静脉CSA、平均动脉压(MAP)、心率(HR)和血管活性药使用次数。结果所有患者的右侧颈内静脉清晰可见。与P0组相比,T组、P10组和C组患者颈内静脉CSA均有增加(均<0.01);与C组比较,P10组颈内静脉CSA显著减小(<0.05)。4组MAP差异有统计学意义(<0.05),与P0组比较,C组MAP降低(<0.05)。结论 10 cm H_2O PEEP和Trendelenburg体位均能显著增加喉罩全身麻醉患者右侧颈内静脉CSA,联合应用可能影响循环稳定。Objective To explore the effect of trendelenburg position and positive end-expiratory pressure(PEEP)on the cross-sectional area(CSA)of internal jugular vein(UV)in general anesthesia of laryngeal mask airway(LMA).Methods 60 American Society of Anesthesiologists(ASA)I or II grade patients undergoing elective operation re-ceived general anesthesia using LMA,were included in this study and randomly divided to 4 groups:PEEP 0 cmH20(group P0)、trendelenburg position(group T)、PEEP 10 cmH20(group PI0)and combination of trendelenbuig position and PEEP 10 cmH20(group C)in a random order.The UV was investigated by ultrasonography.The CSA of UV was measured after applying 4 maneuvers respectively.The mean arterial pressure(MAP),heartrate,and vasoactive drugs used were recorded at 4 time points.Results Compared to group P0,the CSA of UV in group T,P10 and C signifi-cantly increased by 46%,38%and 59%,respectively(allP<0.0l).There was no sigjiiflcant difference in the CSA of IJV between group P10 and T(P>0.05).Compared to group C,the CSA of IJV in group P10 was significantly decre-ased(P<0.05).There was no significant difference in the CSA of UV between group T and C(P>0.05).There was no significant changes in heart rate(P>0.05).MAP decreased significantly by 9.1%in group C compared to group P0.No atropine or norepinephrine was needed for all patients.Conclusions 10 cmH20 PEEP and trendelenbuig position both increases the CSA of IJV in general anaesthesia of LMA,combination application might affect the stability of ha-emodynamics.

关 键 词：全身麻醉 喉罩 颈内静脉横截面积 呼气末正压 

分 类 号：R614[医药卫生—麻醉学]