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[1]范国祥,薛官国,孙杰,等.术中不同时期呼气末正压通气对全身麻醉老年患者血气指标和肺顺应性的影响[J].医学研究与战创伤救治(原医学研究生学报),2017,19(04):369-371.[doi:10.3969/j.issn.1672-271X.2017.04.009]
　FAN Guo-xiang,XUE Guan-guo,SUN Jie,et al.Effects of ventilation with and positive end-expiratory pressure in different periods onarterial blood gas analysis index and lung compliance in elderly patients undergoing abdominal surgery with general anesthesia[J].JOURNAL OF MEDICALRESEARCH —COMBAT TRAUMA CARE,2017,19(04):369-371.[doi:10.3969/j.issn.1672-271X.2017.04.009]
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术中不同时期呼气末正压通气对全身麻醉老年患者血气指标和肺顺应性的影响()
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《医学研究与战创伤救治》（原医学研究生学报）[ISSN:1672-271X/CN:32-1713/R]

卷:
第19卷
期数:
2017年04期
页码:
369-371
栏目:
出版日期:
2017-08-10

文章信息/Info

Title:
Effects of ventilation with and positive end-expiratory pressure in different periods onarterial blood gas analysis index and lung compliance in elderly patients undergoing abdominal surgery with general anesthesia
作者:
范国祥1; 薛官国2; 孙杰3; 丁正年3
作者单位：1.211166南京，南京医科大学附属逸夫医院麻醉科；2. 211103南京，南京市江宁区第二人民医院麻醉科；3.210029南京，南京医科大学第一附属医院麻醉科
Author(s):
FAN Guo-xiang1; XUE Guan-guo2; SUN Jie3; DING Zheng-nian3
(1.Department of Anesthesiology，Sir Run Run Hospital,Nanjing Medical University，Nanjing 211166，Jiangsu，China；2.Department of Anesthesiology, the Second People′s Hospital of Jiangning，Nanjing 211103，Jiangsu，China；3.Department of Anesthesiology, the First A
关键词:
呼气末正压通气; 老年患者; 腹部手术; 血气指标; 肺顺应性
Keywords:
Positive end-expiratory pressure;  The elderly patients;  Abdominal surgery;  Arterial blood gas analysis;  Lung compliance
分类号:
R614.2
DOI:
10.3969/j.issn.1672-271X.2017.04.009
文献标志码:
A
摘要:
目的 探讨术中低潮气量复合不同时期呼气末正压通气（PEEP）的保护性肺通气策略对开腹手术全身麻醉老年患者动脉血气分析指标和肺顺应性的影响。方法 选择接受开放性腹部手术的老年全身麻醉患者60例，随机分为常规通气组、中期PEEP组和后期PEEP组。常规通气组未复合PEEP，中期PEEP组在手术开始后1 h 复合PEEP，后期PEEP组在拔管前1h复合PEEP,各组PEEP设定为10cmH2O，持续1h。3组均采用间歇性正压通气（IPPV）模式，潮气量为6mL/kg，吸呼比为1∶1.5～2，调节呼吸频率，维持呼气末二氧化碳分压(PETCO2) 在35～45mmHg（1mmHg=0.133kPa）。分别于术前、术后1h、术后24h抽取动脉血行血气分析，并记录气管插管后30min、术中90min和拔管前30min的潮气量、PEEP值、气道峰压(Ppeak)，计算肺顺应性(CL)。结果 与术前比较，术后1h各组PaCO2明显升高（P<0.05），常规通气组和后期PEEP组氧合指数（OI）明显降低（P<0.05），常规通气组和中期PEEP组肺泡-动脉氧分压差（A-aDO2）明显升高（P<0.05）；与术后1h比较，术后24h中期PEEP组PaCO2明显降低（P<0.05），常规通气组OI明显升高（P<0.05），常规通气组和中期PEEP组A-aDO2明显下降（P<0.05），其余差异无统计学意义（P>0.05）。结论 低潮气量复合术中1h PEEP或拔除气管导管前1h复合PEEP均能改善术后血气指标，前者可以改善术后1h和术后24h的氧合功能。
Abstract:
Objective To investigate the effects of protective lung ventilation strategy with low tidal volume and positive end-expiratory pressure (PEEP) in different periods on arterial blood gas analysis index and lung compliance in elderly patients undergoing abdominal surgery with general anesthesia.Methods Sixty elderly patients undergoing open abdominal surgery with general anesthesia were randomly divided into routine ventilation group (group A), medium phase of PEEP group (group B) and later phase of PEEP group (group C). Not compound PEEP group A, group B compound PEEP 1 h after the beginning of surgery and group C compound PEEP 1 h before extubation, constituting the setting of 10 cmH2O, last 1 h. Three groups all use of intermittent positive pressure ventilation (IPPV) model, the tidal volume of 6 mL/kg, inspiratory expiratory ratio of 1∶1.5-2, maintain PETCO2 in 35-45 mmHg by adjusting respiratory rate. Respectively preoperative, postoperative 1 hour and postoperative 24 hours were collected in the arterial blood gas analysis, and record the tidal volume (VT), PEEP, the airway peak pressure (Peak) in 30 min after tracheal intubation, 90 min after the beginning of surgery and 30 min before extubation, and calculate lung compliance (CL).Results Compared with the reoperative, PaCO2 increased significantly in postoperative 1 h group, OI decreased significantly in group A and group C, A-aDO2 were significantly increased in group A and group B. Compared with postoperative 1 h, postoperative 24 h PaCO2 decreased in group B, OI was significantly increased in group A and A-aDO2 decreased significantly in group A and group B. There was no statistically significant difference remaining.Conclusion Low tidal volume combined with 1H intraoperative PEEP or PEEP 1 h before extubation can improve postoperative blood gas indexs, the former can improve oxygenation function of postoperative 1 h and postoperative 24 h.

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备注/Memo:
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更新日期/Last Update: 2017-07-20