不同潮气量机械通气模式对房颤导管射频消融手术影响的比较  

Comparison of the Effects of Mechanical Ventilation Pattern in Different Tidal Volume on The Radiofrequency Catheter Ablation of Atrial Fibrillation.

作　　者：池小薇 蒲淳 李强 付强 Chi Xiaowei;Pu Chun;Li Qiang(Department of Anesthesiology,Third People′s Hospital of Chengdu Affiliated to Southwest Jiaotong University,Chengdu,Sichuan 610031,China.)

机构地区：[1]西南交通大学附属医院/成都市第三人民医院麻醉科,四川成都610031

出　　处：《四川医学》2022年第1期34-38,共5页Sichuan Medical Journal

摘　　要：目的为比较不同潮气量机械通气模式对全身麻醉下房颤导管射频消融术的影响。方法回顾性分析我院2020年1月至2020年12月于全身麻醉下行房颤导管射频消融手术的患者192例,根据通气模式不同分为常规小潮气量机械通气组(A组112例)、间歇极小潮气量机械通气组(B组80例)。术中呼吸参数设置:A组:VT 6~8 ml/kg, RR 12次/min, PEEP 3 cmH;O;B组:VT 6~8 ml/kg, RR 12次/min, PEEP 3 cmH;O,消融开始时以极小潮气量通气模式VT 4 ml/kg, RR 24次/min, SPO;下降至95%时恢复常规小潮气量通气模式。记录两组手术时间、消融时间、X线暴露时间、并发症并进行比较。分别于麻醉前(T1)、消融开始前(T2)、消融结束后即刻(T3)、清醒拔管后30 min(T4)、术后24 h(T5)行血气分析,记录pH、PaCO_(2),计算氧合指数(OI=PaO;/FiO;),记录各时刻平均动脉压(MAP)、心率(HR)。结果 T3时刻B组PaCO;高于A组(P<0.05),其余时刻PaCO;差异无统计学意义,两组各时刻MAP、HR、OI差异无统计学意义。B组手术时间、消融时间、X线暴露较A组时间明显缩短(P<0.05)。两组不良反应发生率差异无统计学意义。结论进行肺保护性通气结合间歇极小潮气量通气策略可安全应用于房颤导管射频消融术。Objective To evaluate the effect of mechanical ventilation pattern in different tidal volume on the radiofrequency catheter ablation of atrial fibrillation.Methods The medical records of 192 cases of radiofrequency ablation of atrial fibrillation catheters under general anesthesia from January 2020 to December 2020 in the author s hospital were retrospectively analyzed,including the conventional small tidal volume mechanical ventilation group(group A,n=112)and the intermittent very small tidal volume mechanical ventilation group(group B,n=80).The intraoperative ventilation mode of group A was set as VT 6 ml/kg to 8 ml/kg,RR 12 times/min and PEEP 3 cmH 2 O.In group B,VT 6 ml/kg to 8 ml/kg,RR 12 times/min and PEEP 3 cmH 2 O were used.The minimal tidal volume mechanical ventilation mode was employed when the ablation started,with VT 4 ml/kg and RR 24 times/min,and when SPO 2 decreased to 95%,the normal low tidal volume ventilation mode was resumed.The duration of surgery,ablation time,X-ray fluoroscopy time,complications were collected and compared.Blood samples were collected before anesthesia(T1),before the start of ablation(T2),after the completion of ablation immediately(T3),30 min after the extubation(T4),24 hours after ablation(T5)for blood gas analysis.pH,PaCO 2,MAP,HR were recorded at each time point.Oxygenation index(OI)was calculated.Results Compared with group A,the value of PaCO 2 in group B was significantly higher at T3(P<0.05).There was no significant difference in MAP,HR or OI between the two groups at each time point.Compared with group A,the duration of surgery,ablation time and X-ray fluoroscopy time in group B were significantly shorter(P<0.05).There was no significant difference in complications between the two groups.Conclusion Performing lung protective ventilation combined with intermittent minimal tidal volume ventilation can be safely applied in radiofrequency catheter ablation of atrial fibrillation.

关 键 词：心房颤动 导管射频消融术 全身麻醉 肺保护性通气 极小潮气量通气 

分 类 号：R614.2[医药卫生—麻醉学]