上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2017, Vol. 37 ›› Issue (10): 1413-.doi: 10.3969/j.issn.1674-8115.2017.10.021?

• 论著（临床研究） • 上一篇    下一篇

小潮气量加低水平呼气末正压通气对全身麻醉哮喘患者呼吸功能的影响

吴雷 1*，夏一梦 2*，范秋维 2   

  1. 1. 河南省许昌市中心医院麻醉科，许昌 461000；2. 上海交通大学 医学院附属瑞金医院麻醉科，上海 200025
  • 出版日期:2017-10-28 发布日期:2017-11-01
  • 通讯作者: 范秋维，电子信箱：qiuweifan630906@icloud.com
  • 作者简介:?吴雷（1979—），男，主治医师，学士；电子信箱：33763602@qq.com。夏一梦（1981—），女，主治医师，博士；电子信箱：49244046@qq.com。 * 共同第一作者。

Effects of low tidal volume mechanical ventilation and low level of positive end expiratory pressure on respiratory function in patients with asthma under general anesthesia#br#

WU Lei1*, XIA Yi-meng2*, FAN Qiu-wei2   

  1. 1. Department of Anesthesiology, Xuchang Central Hospital, Xuchang 461000, China; 2. Department of Anesthesiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Online:2017-10-28 Published:2017-11-01

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摘要：  ] 的 · 探究小潮气量间歇正压通气（IPPV）联合低水平呼气末正压通气（PEEP）对哮喘患者全身麻醉时呼吸功能的影响。 方法 · 选取全身麻醉下行上腹部手术的哮喘患者45 例，随机分为3 组，每组15 例：A 组常规潮气量（10 mL/kg）IPPV，B 组小潮 气量（6 mL/kg）IPPV，C 组小潮气量（6 mL/kg）IPPV 加低水平PEEP（5 cmH2O）。分别记录麻醉诱导后即刻及诱导后5、30、60、 120 min 的气道峰压（Ppeak），并计算肺泡动态顺应性（Cdyn）。监测麻醉诱导前脱氧 5 min 和麻醉诱导后 60、120 min 动脉血气；记 录血氧分压（PaO2）和血二氧化碳分压（PaCO2）数值。结果 · 与 A 组相比，C 组各时段Ppeak 均明显降低（P<0.01），而在麻醉诱 导后60、120 min Cdyn 均显著增高（P<0.05）。与 A 和 B 组相比，C 组在麻醉诱导后60、120 min PaO2 也明显升高（P<0.01）而 PaCO2 则明显降低（P<0.05）。 结论 · 对哮喘患者而言，小潮气量联合低水平 PEEP 模式可降低气道压力，提高肺动态顺应性，改善 氧合参数，是一种安全有效的麻醉呼吸管理模式。

关键词:  小潮气量, 间歇正压通气, 呼气末正压通气, 哮喘

Abstract:

 Objective · To investigate the effects of low tidal volume mechanical ventilation and low level of positive end expiratory pressure (PEEP) on respiratory function in patients with asthma under general anesthesia.  Methods · Forty-five patients with asthma undergoing upper abdominal surgery under general anesthesia were selected and randomly divided into three groups, with 15 cases in each group. Group A received a regular tidal volume of 10 mL/kg, group B a low tidal volume of 6 mL/kg and group C a low tidal volume of 6 mL/kg combined with 5 cmH2O PEEP. Ppeak was recorded at different time points, including the time of induction under anesthesia and the time of 5, 30 and 60 minutes after anesthesia induction. Based on such parameters, Cdyn were also calculated. Moreover, blood gas analysis index (PaO2 and PaCO2) were documented at the time of deoxidation period for 5 minutes before induction and 60 and 120 minutes after induction of anesthesia.  Results · The Ppeak values in goup C were significantly lower at all times (P<0.01) and Cdyn at the time of 60 and 120 minutes after induction were significantly higher (P<0.05) than group A. At the time of 60 and 120 minutes after induction, the levels of PaO2 were also increased (P<0.01) while the levels of PaCO2 was significantly decreased (P<0.05) in group C compared to group A and group B respectively.  Conclusion · The intermittent positive pressure ventilation of low tidal volume combined with low level of PEEP is a safe and effective mechanical ventilation method for asthma patients under general anesthesia, which can reduce airway peak pressure, enhance pulmonary dynamic compliance and improve the oxygenation index.

Key words:  low tidal volume, intermittent positive pressure ventilation, positive end expiratory pressure, asthma