中华生物医学工程杂志
中華生物醫學工程雜誌
중화생물의학공정잡지
CHINESE JOURNAL OF BIOMEDICAL ENGINEERING
2014年
2期
139-141
,共3页
赵子良%岑燕遗%龚婷%梁荣丰
趙子良%岑燕遺%龔婷%樑榮豐
조자량%잠연유%공정%량영봉
麻醉,全身%同步间歇指令通气%喉面罩%输尿管软镜
痳醉,全身%同步間歇指令通氣%喉麵罩%輸尿管軟鏡
마취,전신%동보간헐지령통기%후면조%수뇨관연경
Anesthesia,general%Synchronized intermittent mandatory ventilation%Laryngeal mask%Flexible ureteroscopy
目的 评价输尿管软镜术中应用喉罩同步间歇指令通气(SIMV)的通气效果.方法 选择2013年6月至9月广州医科大学附属第一医院泌尿外科收治的拟在输尿管软镜下行钬激光碎石术的肾结石患者30例,美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级.使用丙泊芬、舒芬太尼麻醉诱导,手控辅助呼吸至患者自主呼吸消失,置入喉罩,连接麻醉机行SIMV.手术结束继续应用SIMV至患者呼吸恢复良好.记录麻醉前(T1)、喉罩置入后通气5 min(T2)、手术结束(T3)和拔除喉罩患者自主呼吸5min(T4)4个时点的脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)和pH值,记录T2和T3时点气道峰压(Ppeak)、分钟通气量(MV)、动态顺应性(Cdyn)、呼气末二氧化碳分压(PmTCO2)和压力-容量环(P-V环)、PETCO2波形.结果 4个时点的PaO2、PaCO2、pH值和SpO2均在正常范围.T2和T3时点的PaO2明显高于T1和T4时点(均P＜ 0.05).术中行喉罩SIMV时,T2和T3时点的Ppeak、MV、Cdyn、PETCO2差异无统计学意义(均P＞ 0.05),P-V环和PETCO2波形无改变.结论 全身麻醉下输尿管软镜术中应用喉罩SIMV能保持良好的通气效果.
目的 評價輸尿管軟鏡術中應用喉罩同步間歇指令通氣(SIMV)的通氣效果.方法 選擇2013年6月至9月廣州醫科大學附屬第一醫院泌尿外科收治的擬在輸尿管軟鏡下行鈥激光碎石術的腎結石患者30例,美國痳醉醫師協會(ASA)分級Ⅰ～Ⅱ級.使用丙泊芬、舒芬太尼痳醉誘導,手控輔助呼吸至患者自主呼吸消失,置入喉罩,連接痳醉機行SIMV.手術結束繼續應用SIMV至患者呼吸恢複良好.記錄痳醉前(T1)、喉罩置入後通氣5 min(T2)、手術結束(T3)和拔除喉罩患者自主呼吸5min(T4)4箇時點的脈搏血氧飽和度(SpO2)、動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2)和pH值,記錄T2和T3時點氣道峰壓(Ppeak)、分鐘通氣量(MV)、動態順應性(Cdyn)、呼氣末二氧化碳分壓(PmTCO2)和壓力-容量環(P-V環)、PETCO2波形.結果 4箇時點的PaO2、PaCO2、pH值和SpO2均在正常範圍.T2和T3時點的PaO2明顯高于T1和T4時點(均P＜ 0.05).術中行喉罩SIMV時,T2和T3時點的Ppeak、MV、Cdyn、PETCO2差異無統計學意義(均P＞ 0.05),P-V環和PETCO2波形無改變.結論 全身痳醉下輸尿管軟鏡術中應用喉罩SIMV能保持良好的通氣效果.
목적 평개수뇨관연경술중응용후조동보간헐지령통기(SIMV)적통기효과.방법 선택2013년6월지9월엄주의과대학부속제일의원비뇨외과수치적의재수뇨관연경하행화격광쇄석술적신결석환자30례,미국마취의사협회(ASA)분급Ⅰ～Ⅱ급.사용병박분、서분태니마취유도,수공보조호흡지환자자주호흡소실,치입후조,련접마취궤행SIMV.수술결속계속응용SIMV지환자호흡회복량호.기록마취전(T1)、후조치입후통기5 min(T2)、수술결속(T3)화발제후조환자자주호흡5min(T4)4개시점적맥박혈양포화도(SpO2)、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)화pH치,기록T2화T3시점기도봉압(Ppeak)、분종통기량(MV)、동태순응성(Cdyn)、호기말이양화탄분압(PmTCO2)화압력-용량배(P-V배)、PETCO2파형.결과 4개시점적PaO2、PaCO2、pH치화SpO2균재정상범위.T2화T3시점적PaO2명현고우T1화T4시점(균P＜ 0.05).술중행후조SIMV시,T2화T3시점적Ppeak、MV、Cdyn、PETCO2차이무통계학의의(균P＞ 0.05),P-V배화PETCO2파형무개변.결론 전신마취하수뇨관연경술중응용후조SIMV능보지량호적통기효과.
Objective To evaluate the ventilation efficiency of synchronized intermittent mandatory ventilation (SIMV) via a laryngeal mask airway during flexible ureteroscopy.Methods Thirty kidney stone patients scheduled for holmium laser lithotripsy under flexible ureteroscopy from Department of Urinary Surgery,The First Affiliated Hospital,Guangzhou Medical University between June 2013 and September 2013 were enrolled.The patients were rated as grades Ⅰ-Ⅱ according to American Society of Anesthesiologists (ASA).General anesthesia was induced with propofol and sufentanil,and the patient was ventilated by manual assisted maneuver till cease of spontaneous respiration,then a laryngeal mask airway was placed and connected to the anesthesia apparatus for SIMV.SIMV was continuously applied throughout the operation until patients had good respiratory recovery.Pulse oxygen saturation (SpO2),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2) and pH value were recorded at 4 time points:immediately prior to anesthesia (T1),5 min after laryngeal mask airway ventilation (T2),immediately after procedure (T3) and 5 min after laryngeal mask airway removal and recovery of spontaneous respiration (T4).Peak airway pressure (Peak),minute volume (MV),dynamic compliance (Cdyn),end-tidal pressure of carbon dioxide (PETCO2),pressure-volume ring (P-V ring) and PETCO2 waveform at T2 and T3 time points were also recorded.Results PaO2,PaCO2,pH value and SpO2 at all 4 time points were within normal range.PaO2 at T2 and T3 were apparently higher than those at T1 and T4 (all P＜0.05).During SIMV via laryngeal mask airway in the operation,there was no statistical difference in Peak,MV,Cdyn and PErCO2 between T2 and T3 (all P＞0.05),and there was no obvious change in P-V ring and PETCO2 waveform also.Conclusion SIMV via a laryngeal mask airway is effective for maintenance of favorable ventilation during flexible ureteroscopy under general anesthesia.
