医药前沿
醫藥前沿
의약전연
YIAYAO QIANYAN
2014年
1期
60-61
,共2页
邓军%韦克(通讯作者)%李明良%左朝晖%赵兰花
鄧軍%韋剋(通訊作者)%李明良%左朝暉%趙蘭花
산군%위극(통신작자)%리명량%좌조휘%조란화
理想体重%潮气量%过度通气%肺氧合功能
理想體重%潮氣量%過度通氣%肺氧閤功能
이상체중%조기량%과도통기%폐양합공능
Ideal Body Weight%Tidal Volume%Hyperventilation%Pulmonary oxygenation function
目的：比较不同潮气量对体重超重患者肺氧合功能的影响，寻求一种保护肺氧合功能通气模式。资料与方法：80例患者随机分为4个组：对照组（男/女）、实验组（男/女）。对照组潮气量=体重（kg）×8ml/kg，实验组潮气量=理想体重×8ml/kg。所有患者均采用丙泊酚、瑞芬太尼以及顺阿曲库铵诱导。气管插管后，按各组预设置的潮气量调节机械通气潮气量。丙泊酚复合瑞芬太尼持续靶控输注以及顺阿曲库铵间断静脉注射。机械通气开始时（T1）、机械通气1小时（T2）、手术结束时（T3）以及复苏拔管前（T4）分别作血气分析和监测气道压力。结果：1、对照组潮气量与实验组潮气量之间比较（P<0.05），有统计学意义。2、男对照组T3氧合指数（O I）<300例数与实验组分别是10例，3例；女对照组T3氧合指数<300例数与实验组分别是8例、1例；对照组T3氧合指数<300例数与实验组比较（P <0.05），有统计学意义。3、T2及T3动脉血二氧化碳分压（PaCO2）与实验组比较（P<0.05），有统计学意义。结论：实验组通气模式避免过度通气，减少肺氧合功能障碍风险，是一种“小潮气量”肺保护通气模式。
目的：比較不同潮氣量對體重超重患者肺氧閤功能的影響，尋求一種保護肺氧閤功能通氣模式。資料與方法：80例患者隨機分為4箇組：對照組（男/女）、實驗組（男/女）。對照組潮氣量=體重（kg）×8ml/kg，實驗組潮氣量=理想體重×8ml/kg。所有患者均採用丙泊酚、瑞芬太尼以及順阿麯庫銨誘導。氣管插管後，按各組預設置的潮氣量調節機械通氣潮氣量。丙泊酚複閤瑞芬太尼持續靶控輸註以及順阿麯庫銨間斷靜脈註射。機械通氣開始時（T1）、機械通氣1小時（T2）、手術結束時（T3）以及複囌拔管前（T4）分彆作血氣分析和鑑測氣道壓力。結果：1、對照組潮氣量與實驗組潮氣量之間比較（P<0.05），有統計學意義。2、男對照組T3氧閤指數（O I）<300例數與實驗組分彆是10例，3例；女對照組T3氧閤指數<300例數與實驗組分彆是8例、1例；對照組T3氧閤指數<300例數與實驗組比較（P <0.05），有統計學意義。3、T2及T3動脈血二氧化碳分壓（PaCO2）與實驗組比較（P<0.05），有統計學意義。結論：實驗組通氣模式避免過度通氣，減少肺氧閤功能障礙風險，是一種“小潮氣量”肺保護通氣模式。
목적：비교불동조기량대체중초중환자폐양합공능적영향，심구일충보호폐양합공능통기모식。자료여방법：80례환자수궤분위4개조：대조조（남/녀）、실험조（남/녀）。대조조조기량=체중（kg）×8ml/kg，실험조조기량=이상체중×8ml/kg。소유환자균채용병박분、서분태니이급순아곡고안유도。기관삽관후，안각조예설치적조기량조절궤계통기조기량。병박분복합서분태니지속파공수주이급순아곡고안간단정맥주사。궤계통기개시시（T1）、궤계통기1소시（T2）、수술결속시（T3）이급복소발관전（T4）분별작혈기분석화감측기도압력。결과：1、대조조조기량여실험조조기량지간비교（P<0.05），유통계학의의。2、남대조조T3양합지수（O I）<300례수여실험조분별시10례，3례；녀대조조T3양합지수<300례수여실험조분별시8례、1례；대조조T3양합지수<300례수여실험조비교（P <0.05），유통계학의의。3、T2급T3동맥혈이양화탄분압（PaCO2）여실험조비교（P<0.05），유통계학의의。결론：실험조통기모식피면과도통기，감소폐양합공능장애풍험，시일충“소조기량”폐보호통기모식。
Objective: To compare the different tide volumes’impact on pulmonary oxygenation function in over weight patients, a kind of ventilation model which could protect pulmonary oxygenation function was found .Material and Method : 80 patients were be randomly divided into 4 groups: the male control group, the female control group, the male experiment group and the female control group. The control group’s tidal volume (VT) = body weight × 8ml/kg, the experiment group’s VT = ideal body weight×8 ml/kg. Propofol, remifentanil and cis-atracurium were respectively adopted to al patients by vein, during induction of anesthesia. After tracheal intubation, the ventilation of tidal volume were adjusted to each group’s preset volume tide. Propofol and remifentanil also were continuously target control infused during maintenance of anesthesia . Cis-atracurium was discontinuously used by vein . The blood gas analysis and air way pressure were respectively monitored at mechanical ventilation start(T1), the post mechanical ventilation 1 hour(T2) , the end-operation (T3) and the respiratory recovery before extubation (T4).Results: 1.The volume tide in the control group and in the experiment group were compared(P <0.05). The difference was significant.2. Patients which oxygenation index(OI) at T3 less than 300 in the female control group and these in the female experiment group were 8, 1 , respectively. Patients whose oxygenation index at T3 were less than 300 in the male control group and those in the male experiment group were 10, 3, respectively. Patients whose oxygenation index at T3 was less than 300 in the male control group and those in the experiment group was compared(P <0.05), the difference was significant . 3.The arterial carbon dioxide pressure(PaCO2) at T2 and PaCO2 at T3 in the control group and in the experiment group were compared respectively(P <0.05), the difference was significant Conclusion: The ventilation model in the experiment group avoided hyperventilation and decrease the risk of Pulmonary oxygenation dysfunction than in the control group. It was a kind of little tide volume pulmonary protected ventilation model.
