国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2010年
5期
404-407
,共4页
腹腔镜%妇科%肥胖%机械通气%呼吸力学
腹腔鏡%婦科%肥胖%機械通氣%呼吸力學
복강경%부과%비반%궤계통기%호흡역학
Laparoscopy%Gynecology%Obesity%Ventilation%Respiratory mechanics
目的 观察肥胖患者行妇科腹腔镜手术时,两种不同的机械通气模式对患者血流动力学、呼吸力学、动脉氧合的影响. 方法 选择40例行妇科腹腔镜手术的肥胖患者,按数字表法随机分为压力控制通气组(pressure-controlled ventilation,PCV)和容量控制通气组(volume-controlled yentilation,VCV),每组20例.两组患者均实施全凭静脉麻醉方案,分别采用不同的通气模式,维持呼气末二氧化碳分压(end-tial carbon dioxide partial pressure,PETCO2)在35 mm Hg～45 mm Hg(1 mm Hg=0.133kPa)之间.分别于麻醉前5 min(T0)、气腹开始前5 min(T1)、气腹后30min(T2)、气腹解除后5 min(T3)、拔除气管导管时(T4),采集动脉血行血气分析,监测和计算血流动力学指标、血气分析指标、呼吸力学指标. 结果 ①在T1、T2、T3 PCV组的PaO2、氧合指数(oxygenation index,OI)(分别为460±78、453±83、463±95)均高于VCV组(P<0.05);PCV组的肺泡动脉血氧分压差(A-aDO2)(分别为74±25、80±30、82±26)、呼吸指数(respiratory index,RI)(分别为0.32±0.08、0.33±0.10、0.34±0.13)明显低于VCV组(P<0.05).②与T0比较,两组在T2、T3、T4 PaCO2明显升高、pH值明显下降(P<0.05);与VCV组比较,PCV组在各时点差异无统计学意义.③与VCV组比较,PCV组在T2气道峰压Ppeak(27.8±1.6)较低(P<0.05). 结论 PCV在肥胖患者的妇科腹腔镜手术麻醉中改善通气与血流比例,促进气体交换.
目的 觀察肥胖患者行婦科腹腔鏡手術時,兩種不同的機械通氣模式對患者血流動力學、呼吸力學、動脈氧閤的影響. 方法 選擇40例行婦科腹腔鏡手術的肥胖患者,按數字錶法隨機分為壓力控製通氣組(pressure-controlled ventilation,PCV)和容量控製通氣組(volume-controlled yentilation,VCV),每組20例.兩組患者均實施全憑靜脈痳醉方案,分彆採用不同的通氣模式,維持呼氣末二氧化碳分壓(end-tial carbon dioxide partial pressure,PETCO2)在35 mm Hg～45 mm Hg(1 mm Hg=0.133kPa)之間.分彆于痳醉前5 min(T0)、氣腹開始前5 min(T1)、氣腹後30min(T2)、氣腹解除後5 min(T3)、拔除氣管導管時(T4),採集動脈血行血氣分析,鑑測和計算血流動力學指標、血氣分析指標、呼吸力學指標. 結果 ①在T1、T2、T3 PCV組的PaO2、氧閤指數(oxygenation index,OI)(分彆為460±78、453±83、463±95)均高于VCV組(P<0.05);PCV組的肺泡動脈血氧分壓差(A-aDO2)(分彆為74±25、80±30、82±26)、呼吸指數(respiratory index,RI)(分彆為0.32±0.08、0.33±0.10、0.34±0.13)明顯低于VCV組(P<0.05).②與T0比較,兩組在T2、T3、T4 PaCO2明顯升高、pH值明顯下降(P<0.05);與VCV組比較,PCV組在各時點差異無統計學意義.③與VCV組比較,PCV組在T2氣道峰壓Ppeak(27.8±1.6)較低(P<0.05). 結論 PCV在肥胖患者的婦科腹腔鏡手術痳醉中改善通氣與血流比例,促進氣體交換.
목적 관찰비반환자행부과복강경수술시,량충불동적궤계통기모식대환자혈류동역학、호흡역학、동맥양합적영향. 방법 선택40례행부과복강경수술적비반환자,안수자표법수궤분위압력공제통기조(pressure-controlled ventilation,PCV)화용량공제통기조(volume-controlled yentilation,VCV),매조20례.량조환자균실시전빙정맥마취방안,분별채용불동적통기모식,유지호기말이양화탄분압(end-tial carbon dioxide partial pressure,PETCO2)재35 mm Hg～45 mm Hg(1 mm Hg=0.133kPa)지간.분별우마취전5 min(T0)、기복개시전5 min(T1)、기복후30min(T2)、기복해제후5 min(T3)、발제기관도관시(T4),채집동맥혈행혈기분석,감측화계산혈류동역학지표、혈기분석지표、호흡역학지표. 결과 ①재T1、T2、T3 PCV조적PaO2、양합지수(oxygenation index,OI)(분별위460±78、453±83、463±95)균고우VCV조(P<0.05);PCV조적폐포동맥혈양분압차(A-aDO2)(분별위74±25、80±30、82±26)、호흡지수(respiratory index,RI)(분별위0.32±0.08、0.33±0.10、0.34±0.13)명현저우VCV조(P<0.05).②여T0비교,량조재T2、T3、T4 PaCO2명현승고、pH치명현하강(P<0.05);여VCV조비교,PCV조재각시점차이무통계학의의.③여VCV조비교,PCV조재T2기도봉압Ppeak(27.8±1.6)교저(P<0.05). 결론 PCV재비반환자적부과복강경수술마취중개선통기여혈류비례,촉진기체교환.
Objective To investigate the effects of pressure -controlled ventilation (PCV) and volume -controlled ventilation (VCV) on obese patients undergoing gynecologic laparoscopic surgery by evaluating hemodynamics and respiratory parameters, and arterial oxygenation. Methods Forty obese patients undergoing gynecological laparoscopic surgery were randomly divided into PCV and VCV group (n=20). Patients were all implemented into the program of total intravenous anesthesia, and ventilated with different modes.End-tidal carbon dioxide partial pressure (PETCO2) was maintained between(35-45 ) mm Hg. Arterial blood was collected respectively to analyze blood gas at 5 min before anesthesia (T0), 5 min before the start of pneumoperitoneum (T1),30 min after the start of pneumoperitoneum(T2), 5 min after the end of pneumoperitoneum(T3) and at extubation(T4). Meanwhile, parameters of hemodynamics and respiratory mechanics were monitored and calculated. Results 1 、At T1,T2 and T3, PaO2 and OI (460±78,453±83,463±95)were significantly higher in PCV group (P<0.05), A-aDO2(74±25,80±30,82±26) and RI (0.32±0.08,0.33±0. 10,0.34±0.13 ) was significantly lower (P<0.05) in PCV group. 2. Compared with T0, PaCO2 at T2,T3,T4 in both groups increased significantly and PH decreased significantly (P<0.05); Compared with VCV group, PCV group had no significant difference at each time point. 3. Compared with VCV group, Ppeak(27.8±1.6)in PCV group at T2 was significantly lower(P<0.05). Conclusion The ventilation/perfusion ratio was improved and gas exchange was promoted in obese patients undergoing gynecologic laparoscopic surgery with PCV model.
