岭南现代临床外科
嶺南現代臨床外科
령남현대림상외과
LINGNAN MODERN CLINICS IN SURGERY
2014年
2期
173-176
,共4页
赵子良%龚婷%余革%温晓晖
趙子良%龔婷%餘革%溫曉暉
조자량%공정%여혁%온효휘
面罩%双水平气道正压%无创通气%腹腔镜胆囊切除手术%全身麻醉
麵罩%雙水平氣道正壓%無創通氣%腹腔鏡膽囊切除手術%全身痳醉
면조%쌍수평기도정압%무창통기%복강경담낭절제수술%전신마취
Mask%Bi-level positive airway pressure%Non-invasive ventilation%Laparoscopic cholecystectomy%General anesthesia
目的:探讨面罩双水平气道正压(BiPAP)无创通气在腹腔镜胆囊切除手术全身麻醉中应用的安全可行性。方法40例行腹腔镜胆囊切除手术的患者,随机分为面罩 BiPAP 通气组(I 组)和气管内插管间歇正压通气(IPPV)组(Ⅱ组),每组20例,术中监测平均动脉血压(MAP)、心率(HR)、脉搏血氧饱和度(SpO2)以及Narcotrend 指数(NI),并在麻醉前(T0)、麻醉诱导后(T1)、插管或上面罩后(T2)、机械通气后5 min(T3)、气腹后5 min(T4)、手术结束(T5)、拔管或去面罩后(T6)时点记录其数值;两组患者在 T0、T3、T4、T5时点做血气分析,记录 PaO2、PaCO2、pH 值。结果 I 组 MAP、HR 在 T2和 T6时点低于Ⅱ组(P<0.05),而 I 组 NI 在 T1时点高于Ⅱ组(P<0.05);组内比较Ⅱ组在 T2、T6时点 MAP、HR 显著升高(P<0.05),而 I 组在这两个时点无变化。PaO2、PaCO2、pH 值在T0、T3、T4、T5时点组间比较差异均无统计学意义。结论面罩 BiPAP 无创通气应用于腹腔镜胆囊切除手术全身麻醉能够进行有效通气,且能维持患者血流动力学平稳,是一种安全有效的通气方式。
目的:探討麵罩雙水平氣道正壓(BiPAP)無創通氣在腹腔鏡膽囊切除手術全身痳醉中應用的安全可行性。方法40例行腹腔鏡膽囊切除手術的患者,隨機分為麵罩 BiPAP 通氣組(I 組)和氣管內插管間歇正壓通氣(IPPV)組(Ⅱ組),每組20例,術中鑑測平均動脈血壓(MAP)、心率(HR)、脈搏血氧飽和度(SpO2)以及Narcotrend 指數(NI),併在痳醉前(T0)、痳醉誘導後(T1)、插管或上麵罩後(T2)、機械通氣後5 min(T3)、氣腹後5 min(T4)、手術結束(T5)、拔管或去麵罩後(T6)時點記錄其數值;兩組患者在 T0、T3、T4、T5時點做血氣分析,記錄 PaO2、PaCO2、pH 值。結果 I 組 MAP、HR 在 T2和 T6時點低于Ⅱ組(P<0.05),而 I 組 NI 在 T1時點高于Ⅱ組(P<0.05);組內比較Ⅱ組在 T2、T6時點 MAP、HR 顯著升高(P<0.05),而 I 組在這兩箇時點無變化。PaO2、PaCO2、pH 值在T0、T3、T4、T5時點組間比較差異均無統計學意義。結論麵罩 BiPAP 無創通氣應用于腹腔鏡膽囊切除手術全身痳醉能夠進行有效通氣,且能維持患者血流動力學平穩,是一種安全有效的通氣方式。
목적:탐토면조쌍수평기도정압(BiPAP)무창통기재복강경담낭절제수술전신마취중응용적안전가행성。방법40례행복강경담낭절제수술적환자,수궤분위면조 BiPAP 통기조(I 조)화기관내삽관간헐정압통기(IPPV)조(Ⅱ조),매조20례,술중감측평균동맥혈압(MAP)、심솔(HR)、맥박혈양포화도(SpO2)이급Narcotrend 지수(NI),병재마취전(T0)、마취유도후(T1)、삽관혹상면조후(T2)、궤계통기후5 min(T3)、기복후5 min(T4)、수술결속(T5)、발관혹거면조후(T6)시점기록기수치;량조환자재 T0、T3、T4、T5시점주혈기분석,기록 PaO2、PaCO2、pH 치。결과 I 조 MAP、HR 재 T2화 T6시점저우Ⅱ조(P<0.05),이 I 조 NI 재 T1시점고우Ⅱ조(P<0.05);조내비교Ⅱ조재 T2、T6시점 MAP、HR 현저승고(P<0.05),이 I 조재저량개시점무변화。PaO2、PaCO2、pH 치재T0、T3、T4、T5시점조간비교차이균무통계학의의。결론면조 BiPAP 무창통기응용우복강경담낭절제수술전신마취능구진행유효통기,차능유지환자혈류동역학평은,시일충안전유효적통기방식。
Objective To investigate the feasibility and safety of mask bi-level positive airway pressure (BiPAP) non-invasive ventilation in the laparoscopic cholecystectomy under general anesthesia. Methods Forty cases of laparoscopic cholecystectomy were randomly enrolled into mask BiPAP ventilation group (group I) and endotracheal intubation intermittent positive pressure ventilation (IPPV) group (groupⅡ) with 20 patients in each group. Mean blood pressure (MAP), heart rate (HR), pulse oximetry (SpO2) and Narcotrend Index (NI) were monitored and recorded during operation at the time points as following: before anesthesia (T0), after induction of anesthesia (T1), after the mask or intubation (T2), mechanical ventilation post 5 minutes (T3), pneumoperitoneum post 5 minutes (T4), the end of surgery (T5), and after remove the mask or endotracheal tube (T6). Blood gas analysis was performed at T0, T3, T4, T5 to record PaO2, PaCO2 and PH values. Results MAP and HR in group I at time points T2 and T6 were lower than that in groupⅡ (P<0.05), while NI in group I at T1 point was higher than that in group Ⅱ (P<0.05). Meanwhile, MAP and HR at T2 and T6 point were significantly higher than those other time points in group Ⅱ(P<0.05), However, no difference was noted in group I. There was no significant difference in PaO2, PaCO2 or pH value at T0, T3, T4, T5 time points between the two groups. Conclusion BiPAP mask non-invasive ventilation in laparoscopic cholecystectomy under general anesthesia was safe and feasible through which the effective ventilation and stable dynamics can be maintained.