CAJ | 학술논문

目的评价呼气末正压通气对阻塞性睡眠呼吸暂停综合征(OSAS)肥胖患者全麻术中呼吸功能的影响.方法择期行悬雍垂腭咽成形术的OSAS患者40例,性别不限,年龄26 ～ 57岁,ASAⅠ或Ⅱ级,按照体重将患者分为2组(n=20):正常体重组(A组),BMI＜ 26 kg/m2；肥胖组(B组),BMI＞ 32 kg/m2.静脉注射咪达唑仑、异丙酚、舒芬太尼和顺阿曲库铵麻醉诱导,气管插管后先行非呼气末正压通气60 min,再行呼气末正压通气60 min,PEEP为8 cm H2O,维持PETCO2 35 ～ 45 mm Hg和气道峰压＜ 28 cm H2O.分别于气管插管后5 min(T1)、60min(T2)和120 min(T3)时记录胸肺顺应性(CL)和气道阻力(Raw).于清醒状态未吸纯氧前(T0)和T1-3时,采集足背动脉血样进行血气分析,计算氧合指数(PaO2/FiO2)、呼吸指数(RI)和生理无效腔(VD/VT).记录术后24h内不良反应的发生情况.结果与T0时比较,B组T1和T2时PaO2/FiO2降低,RI升高(P＜0.05)；与T1时比较,B组T3时PaO2/FiO2、CL升高,RI降低(P＜0.05)；与A组比较,B组T1和T2时PaO2/FiO2和CL降低,T1-3时Raw,RI和VD/VT升高(P＜0.05).两组患者术后24 h内均未见心脑血管意外、气胸或肺水肿等不良反应的发生.结论呼气末正压通气(PEEP 8 cm H2O)可抑制OSAS肥胖患者全麻术中肺不张,改善气体交换和胸肺顺应性.
목적 평개호기말정압통기대조새성수면호흡잠정종합정(OSAS)비반환자전마술중호흡공능적영향.방법 택기행현옹수악인성형술적OSAS환자40례,성별불한,년령26 ～ 57세,ASAⅠ혹Ⅱ급,안조체중장환자분위2조(n=20):정상체중조(A조),BMI＜ 26 kg/m2；비반조(B조),BMI＞ 32 kg/m2.정맥주사미체서륜、이병분、서분태니화순아곡고안마취유도,기관삽관후선행비호기말정압통기60 min,재행호기말정압통기60 min,PEEP위8 cm H2O,유지PETCO2 35 ～ 45 mm Hg화기도봉압＜ 28 cm H2O.분별우기관삽관후5 min(T1)、60min(T2)화120 min(T3)시기록흉폐순응성(CL)화기도조력(Raw).우청성상태미흡순양전(T0)화T1-3시,채집족배동맥혈양진행혈기분석,계산양합지수(PaO2/FiO2)、호흡지수(RI)화생리무효강(VD/VT).기록술후24h내불량반응적발생정황.결과 여T0시비교,B조T1화T2시PaO2/FiO2강저,RI승고(P＜0.05)；여T1시비교,B조T3시PaO2/FiO2、CL승고,RI강저(P＜0.05)；여A조비교,B조T1화T2시PaO2/FiO2화CL강저,T1-3시Raw,RI화VD/VT승고(P＜0.05).량조환자술후24 h내균미견심뇌혈관의외、기흉혹폐수종등불량반응적발생.결론 호기말정압통기(PEEP 8 cm H2O)가억제OSAS비반환자전마술중폐불장,개선기체교환화흉폐순응성.
Objective To investigate the effects of positive end expiratory pressure ventilation on respiratory function during general anesthesia in obese patients with obstructive sleep apnea syndrome (OSAS).Methods Forty ASA Ⅰ or Ⅱ patients aged 26-57 yr undergoing elective uvulo-palato-pharyngoplasty (UPPP) were divided into 2 body weight groups (n =20 each):group A normal body weight patients-BMI＜26 kg/m2 and group B obese patients-BMI＞32 kg/m2.Anesthesia was induced with midazolam,propofol and sufentanil.Tracheal intubation was facilitated with cis-atracurium.Anesthesia was maintained with 1.0％ sevoflurane and continuous infusion of propofol and remifentanil and intermittent iv boluses of cis-atracurium.All patients were mechanically ventilated,first without PEEP for 60 min followed by PEEP 8 cm H2O for 60 min.PET CO2 was maintained at 35-45 mm Hg and Peak airway pressure was maintained at ＜28 cm H2O.Chest wall and lung compliance (CL) and airway resistance (Raw) were monitored and recorded at 5 min (T1),60 min (T2) and 120 min (T3) after tracheal intubation.Arterial blood samples were taken before induction of anesthesia when the patients were awake breathing ambient air (baseline,T0) and at T1-T3.PaO2/FiO2,respiratory index (RI) (PA-aO2/PaO2) and physiologic dead space fraction (VD/VT) were calculated.Results PEEP 8 cm H2O significantly increased PaO2/FiO2,CL and decreased RI at T3 as compared with those at T1 in group B,but there was no significant change in PaO2/FiO2,CL and RI when PEEP 8 cm H2 O was applied at T3 as compared with those at T1 in group A.No adverse reaction occurred in the two groups.Conclusion In obese patients with OSAS,PEEP 8 cm H2O can effectively prevent atelectasis and improve gas exchange and compliance.