择期手术患者机械通气潮气量准确设置的研究  

Tidal volume can be accurately predicted during mechanical ventilation in patients undergoing elective surgery

作　　者：沈颖彦[1] 肖旺频[1] 陈艳[1] 徐佳 周红梅[1] Shen Yingyan;Xiao Wangpin;Chen Yan;Xu Jia;Zhou Hongmei(Department of Anesthesology,Second Affiliated Hospital of Jiaxing University,Jiaxing 314000,China)

机构地区：[1]嘉兴市嘉兴学院附属第二医院麻醉科,314000

出　　处：《中华实验外科杂志》2022年第4期733-736,共4页Chinese Journal of Experimental Surgery

基　　金：浙江省嘉兴市科技局资助项目(2019AD32146)。

摘　　要：目的探索择期手术患者机械通气时潮气量(TV)准确设置的方法。方法择期手术患者133例,年龄20~77岁,体重指数(BMI)16~37 kg/m2,美国麻醉医师学会(ASA)分级Ⅰ~Ⅱ级,入室后患者仰卧位呼气结束时,在脐水平测量腹围,在剑突水平测量胸围,同时记录患者的年龄、体重、身高、腹围及胸围等基本体征。诱导气管插管(内径7.5 mm)后行机械通气(以8 ml/kg实际体重设置初始潮气量),呼吸频率为12次/min,吸呼比1∶2。机械通气后30 min取动脉血2 ml行血气分析,当动脉二氧化碳分压(PaCO_(2))>45 mmHg或<35 mmHg时增加或减小潮气量(每次增加或减少潮气量为25 ml),30 min后再次行动脉血气分析,根据PaCO_(2)调整潮气量25 ml。以此类推,直至连续两次PaCO_(2)均在35~45 mmHg之间,记录此时设置的潮气量(1 mmHg=0.133 kPa)。采用双变量相关性分析及逐步回归法多元线性回归分析进行统计学分析。结果最终有100例患者完成研究并进行了统计分析。双变量相关性分析显示,潮气量设置与年龄、身高、体重、腹围、胸围的相关系数(r)分别为-0.198、0.664、0.865、0.639、0.750,其均呈明显相关(P<0.05)。逐步回归法多元线性回归分析显示,年龄、身高和胸围在逐步进入中被剔除(P>0.05),而体重和腹围作为潮气量设置的关键决定因素被纳入回归方程(P<0.01),其回归系数(b)分别为5.717和-2.798,回归方程为,Y=312+5.717X1-2.798X2(Y,潮气量需求;X1,体重;X2,腹围)。回归方程的调整R2为0.813。结论在择期手术患者全身麻醉机械通气期间,根据体重和腹围能准确预测患者所需潮气量,其回归方程为:Y=312+5.717X1-2.798X2(Y,潮气量需求;X1,体重;X2,腹围)。Objective Evidence that tidal volume(TV)is related to age,height,weight,chest circumference,and abdominal circumference exists.However,it is unclear which of these has the strongest association with TV.This study aimed to investigate the main factors associated with TV and determine a method for accurately predicting TV requirement during mechanical ventilation.Methods Between September 2021 to January 2022,we enrolled 133 patients who were scheduled for surgery.Participants’age,height,weight,abdominal circumference,and chest circumference were recorded.Intraoperatively,at 30 min after mechanical ventilation during general anaesthesia,the TV was increased or decreased by 25 ml if the partial pressure of carbon dioxide(PaCO_(2))was>45 mmHg(1 mmHg=0.133 kPa)or<35 mmHg,respectively.This was continued until we observed two consecutive PaCO_(2) values between 35 and 45 mmHg.The TV setting was recorded at this point.Linear regression and multiple regression analyses were performed.Results The data of 100 patients were analyzed.Linear regression analysis showed significant univariate correlations between age,height,weight,abdominal circumference,chest circumference,and the TV requirement(all P<0.05).The correlation coefficients were-0.198,0.664,0.865,0.639,0.750 respectively.Multiple linear regression analysis showed that weight and abdominal circumference were key determinants of the TV requirement(both P<0.01).The adjusted R2 for the regression equation was 0.813.The regression equation for accurately TV requirement was Y=312+5.717X1-2.798X2(Y,TV requirement;X1,weight;and X2,abdominal circumference).Conclusion The regression equation for accurate TV requirement was Y=312+5.717X1-2.798X2.TV requirement can be accurately predicted using weight and abdominal curcumference during mechanical ventilation for general anaesthesia.

关 键 词：潮气量 机械通气 体重 腹围 

分 类 号：R614[医药卫生—麻醉学]