| 摘要: |
| ［摘要］ 目的 研究保护性通气策略［低潮气量（LV）加机械通气（PEEP）］对老年人术中肺顺应性(CL)及氧合的影响。方法 选在气管插管全身麻醉下实施择期开腹手术的老年患者60例（ASA Ⅰ～Ⅱ级，年龄60～81岁），随机分为（1）LV组：VT（潮气量）为7 ml/kg PBW（预测体重）；（2）LV+PEEP组：VT为7 ml/kg PBW,PEEP为5 cmH2O；（3）C组（常规通气量组）：VT为12 ml/kg PBW。分别于插管后5 min(T0)、30 min(T1)、1 h(T2)、3 h(T3)4个时点记录心搏率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、气道峰压（Ppeak）、气道平台压（Pplat）及CL变化，并于各时点桡动脉处抽血测血气指标。结果 三组患者各时点HR、MAP、SpO2、PETCO2及手术种类比较差异无统计学意义（P>0.05）；C组在机械通气期间Pplat、Ppeak明显高于LV组(P=0.001;P=0.012）及LV+PEEP组(P=0.006;P=0.011)；LV组、LV+PEEP组、C组CL均随着时间延长呈下降趋势（P=0.003;P=0.001;P=0.000）,C组明显低于LV组与LV+PEEP组(P=0.004;P=0.001)；LV组与LV+PEEP组差异无统计学意义（P=0.340)。动脉血氧分压（PaO2）在LV组、LV+PEEP组、C组均随着时间延长呈下降趋势（（P=0.002;P=0.002;P=0.000）,C组较LV组与LV+PEEP组降低明显（P=0.001;P=0.001），LV组与LV+PEEP组差异无统计学意义（P=0.231）。结论 与常规大潮气量相比，小潮气量通气（7 ml/kg PBW）能改善老年人术中的氧合及肺顺应性；小PEEP未显示出进一步的肺保护作用。 |
| 关键词: 机械通气 低潮气量 肺顺应性 老年人 |
| DOI：10.3969/j.issn.1674-3806.2012.06.03 |
| 分类号:R 614.2 |
| 基金项目:广西自然科学基金资助项目（编号：0640060） |
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| Effect of protective ventilation strategies on lung compliance and oxygenation in elder patients during surgery |
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ZHU Wei-lin, HUANG Zhong-hua,ZHANG Xue-gang, et al.
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Department of Anesthesiology, the People′s of Guangxi Zhuang Autonomous Region, Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To investigate the effect of three ventilation strategies on lung compliance and oxygenation in elder patients during abdominal surgery. Methods Sixty ASA Ⅰ～Ⅱ elder patients,Aged 60～81 years, scheduled for selective abdominal operation under general anesthesia were randomly divided into three groups: group LV( VT 7 ml/kg PBW)； group LV+PEEP( VT 7 ml/kg PBW, PEEP 5 cmH2O)； group C (VT 12 ml/kg PBW).Pressure controlled ventilation was performed after tracheal intubation, PETCO2 was maintained at normal range through respiratory rate adjusted（RR）.HR，MAP，SpO2， PETCO2，Ppeak,Pplat, CL were monitored continuously and recorded at 5 min(T0),30 min(T1),1 h(T2),3 h(T3) after tracheal intubation；Arterial blood gas analysis were performed at same point. Results Sixty patients were analyzed. There were no significant differences in HR, MAP. PETCO2 and operation methods among the three groups（P>0.05）. Mechanical ventilation with low tidal volumes and low tidal volumes plus PEEP led to lower airway pressures (Pplat and Ppeak, respectively) compared with the C group(P=0.001,P=0.012;P=0.006,P=0.011), and improved CL（P=0.004;P=0.001） and PaO2（P=0.001; P=0.001） in compared with the C group; but CL and PaO2 were decreasing during mechanical ventilation with low tidal volumes (P=0.003;P=0.002) and low tidal volumes plus PEEP(P=0.001;P=0.002).Conclusion Mechanical ventilation with low tidal volumes improves CL and PaO2 in elder patients during abdominal surgery, but not to prevent fully CL and PaO2 from decreasing due to mechanical ventilation,and not to improve these with low tidal volumes adding to low PEEP. |
| Key words: Mechanical ventilation Low tidal volumes Lung compliance Geriatrics patients |
