中国医学创新
中國醫學創新
중국의학창신
MEDICAL INNOVATION OF CHINA
2015年
4期
21-23
,共3页
喉罩%腹腔镜%压控通气%压控反比通气
喉罩%腹腔鏡%壓控通氣%壓控反比通氣
후조%복강경%압공통기%압공반비통기
Laryngeal mask airway%Laparoscopy%Pressure-controlled ventilation%Pressure-controlled inverse ratio ventilation
目的：研究压控反比通气方式对喉罩麻醉下妇科腹腔镜手术患者呼吸动力学的影响。方法：选择30例年龄18~60岁的患者，ASAⅠ~Ⅲ级，计划接受妇科腔镜手术，预期手术时间在45 min以上，使用压控通气模式，吸呼比保持在1：2，PEEP 5 cm H2O，呼吸频率调整在10~12次/min。术中监测无创血压，脉搏血氧饱和度，呼气末正压，5导联肢导心电图等。气腹之后15 min记录数据。此后将吸呼比改为1.5：1，PEEP仍然维持5 cm H2O，反比通气15 min记录数据。结果：压控通气气道峰压在（25.5±3.67）cm H2O，平台压（25.35±3.8）cm H2O。压控反比通气，气道峰压和平台压分别是（25.8±3.86）cm H2O和（25.8±3.41）cm H2O。在压控通气期间平均气道压（13.5±1.35）cm H2O低于压控反比通气时的（17.30±2.08）cm H2O。压控反比通气期间的潮气量（502±49.19）mL也高于压控通气时的（450±38.25）mL。压控反比通气的动态顺应性（24.8±4.25）mL/cm H2O也明显高于压控通气时的（21.50±3.90）mL/cm H2O。结论：吸呼比为1.5：1的压控反比通气在使用喉罩通气的妇科腔镜手术中是一种有效的通气方式。
目的：研究壓控反比通氣方式對喉罩痳醉下婦科腹腔鏡手術患者呼吸動力學的影響。方法：選擇30例年齡18~60歲的患者，ASAⅠ~Ⅲ級，計劃接受婦科腔鏡手術，預期手術時間在45 min以上，使用壓控通氣模式，吸呼比保持在1：2，PEEP 5 cm H2O，呼吸頻率調整在10~12次/min。術中鑑測無創血壓，脈搏血氧飽和度，呼氣末正壓，5導聯肢導心電圖等。氣腹之後15 min記錄數據。此後將吸呼比改為1.5：1，PEEP仍然維持5 cm H2O，反比通氣15 min記錄數據。結果：壓控通氣氣道峰壓在（25.5±3.67）cm H2O，平檯壓（25.35±3.8）cm H2O。壓控反比通氣，氣道峰壓和平檯壓分彆是（25.8±3.86）cm H2O和（25.8±3.41）cm H2O。在壓控通氣期間平均氣道壓（13.5±1.35）cm H2O低于壓控反比通氣時的（17.30±2.08）cm H2O。壓控反比通氣期間的潮氣量（502±49.19）mL也高于壓控通氣時的（450±38.25）mL。壓控反比通氣的動態順應性（24.8±4.25）mL/cm H2O也明顯高于壓控通氣時的（21.50±3.90）mL/cm H2O。結論：吸呼比為1.5：1的壓控反比通氣在使用喉罩通氣的婦科腔鏡手術中是一種有效的通氣方式。
목적：연구압공반비통기방식대후조마취하부과복강경수술환자호흡동역학적영향。방법：선택30례년령18~60세적환자，ASAⅠ~Ⅲ급，계화접수부과강경수술，예기수술시간재45 min이상，사용압공통기모식，흡호비보지재1：2，PEEP 5 cm H2O，호흡빈솔조정재10~12차/min。술중감측무창혈압，맥박혈양포화도，호기말정압，5도련지도심전도등。기복지후15 min기록수거。차후장흡호비개위1.5：1，PEEP잉연유지5 cm H2O，반비통기15 min기록수거。결과：압공통기기도봉압재（25.5±3.67）cm H2O，평태압（25.35±3.8）cm H2O。압공반비통기，기도봉압화평태압분별시（25.8±3.86）cm H2O화（25.8±3.41）cm H2O。재압공통기기간평균기도압（13.5±1.35）cm H2O저우압공반비통기시적（17.30±2.08）cm H2O。압공반비통기기간적조기량（502±49.19）mL야고우압공통기시적（450±38.25）mL。압공반비통기적동태순응성（24.8±4.25）mL/cm H2O야명현고우압공통기시적（21.50±3.90）mL/cm H2O。결론：흡호비위1.5：1적압공반비통기재사용후조통기적부과강경수술중시일충유효적통기방식。
Objective:To investigate the effect of pressure-controlled inverse ratio ventilation using laryngeal mask airway in gynecological laparoscopy.Method:Thirty patients between 18 and 60 years,American Society of Anesthesiologists class 1-3,scheduled for elective major gynecological laparoscopy were included in the study.Size 4 flexible LMAs were used for patients.Pressure-controlled ventilation(PCV)was initiated with tidal volume 8 mL/kg, inspiratory–expiratory(I:E)ratio was kept 1:2,with positive end expiratory pressure(PEEP)of 5 cm H2O. Intraoperative monitoring included noninvasive blood pressure,pulse oximetry,end-tidal carbon dioxide,5-lead EKG, gas monitoring.After 15 min of pneumoperitoneum readings were recorded.I:E ratio was now changed to 1.5:1 on the mode PCV(PCIRV)and PEEP of 5 cm H2O continued.Readings were taken after 15 min of PCIRV.Result:The peak and plateau pressures after pneumoperitoneum during PCV was(25.5±3.67)and(25.35±3.8)cm H2O,respectively and during PCIRV(25.8±3.86)and(25.8±3.41)cm H2O,respectively,and was statistically similar.The mean airway pressure during PCV(13.5±1.35)cm H2O was lower than PCIRV(17.30±2.08)cm H2O(P<0.01).Tidal volume on PCIRV(502±49.19)mL was significantly higher as compared to PCV(450±38.25)mL.The dynamic compliance on PCIRV(24.8±4.25)mL/cm H2O was also significantly higher than PCV(21.50±3.9)mL/cm H2O.Conclusion:PCIRV with I:E ratio 1.5:1 can be an effective mode of ventilation in major gynecological laparoscopy using LMA.
