江西医药
江西醫藥
강서의약
Jiangxi Medical Journal
2015年
10期
993-996
,共4页
小潮气量%呼气末正压%肺泡表面相关蛋白-D%肺保护
小潮氣量%呼氣末正壓%肺泡錶麵相關蛋白-D%肺保護
소조기량%호기말정압%폐포표면상관단백-D%폐보호
Low tidal volume%PEEP%SP-D%Lung protection
目的：研究不同PEEP值下小潮气量机械通气对胃肠手术患者肺的影响。方法45例病例随机分成3组，L1组：小潮气量（8ml/kg）+0cmH2OPEEP，L2组：小潮气量（8ml/kg）+5cmH2OPEEP组，L3组：小潮气量（8ml/kg）+10cmH2OPEEP组，各15例。全麻后按要求设置呼吸参数行机械通气。术中持续监测病人呼吸参数，分别于机械通气30min（T1）、1h(T2)、2h(T3)、3h(T4)及拔管后1h(T5)测动脉血气一次。并于诱导前(T0)、通气3h(T4)、拔管后1h(T5)及术后24h(T6)点采桡动脉血2ml，测定SP-D浓度。结果3组病人肺泡动脉血氧分压差（A-aDo2）组内比较，T5时刻较T1、T2、T3、T4高；组间比较，在T2、T3、T4、T5时L3组的A-aDo2较其他两组都低，差异有统计学意义。血清SP-D浓度，组内比较，L1组和L2组在T6时间点较T0、T4及T5时升高；组间比较，在T6时刻，L3组的较L1组L2组降低，差异有统计学意义。结论复合10cmH2OPEEP的小潮气量机械通气可防止肺不张及肺损伤的发生，更适合于胃肠手术患者。
目的：研究不同PEEP值下小潮氣量機械通氣對胃腸手術患者肺的影響。方法45例病例隨機分成3組，L1組：小潮氣量（8ml/kg）+0cmH2OPEEP，L2組：小潮氣量（8ml/kg）+5cmH2OPEEP組，L3組：小潮氣量（8ml/kg）+10cmH2OPEEP組，各15例。全痳後按要求設置呼吸參數行機械通氣。術中持續鑑測病人呼吸參數，分彆于機械通氣30min（T1）、1h(T2)、2h(T3)、3h(T4)及拔管後1h(T5)測動脈血氣一次。併于誘導前(T0)、通氣3h(T4)、拔管後1h(T5)及術後24h(T6)點採橈動脈血2ml，測定SP-D濃度。結果3組病人肺泡動脈血氧分壓差（A-aDo2）組內比較，T5時刻較T1、T2、T3、T4高；組間比較，在T2、T3、T4、T5時L3組的A-aDo2較其他兩組都低，差異有統計學意義。血清SP-D濃度，組內比較，L1組和L2組在T6時間點較T0、T4及T5時升高；組間比較，在T6時刻，L3組的較L1組L2組降低，差異有統計學意義。結論複閤10cmH2OPEEP的小潮氣量機械通氣可防止肺不張及肺損傷的髮生，更適閤于胃腸手術患者。
목적：연구불동PEEP치하소조기량궤계통기대위장수술환자폐적영향。방법45례병례수궤분성3조，L1조：소조기량（8ml/kg）+0cmH2OPEEP，L2조：소조기량（8ml/kg）+5cmH2OPEEP조，L3조：소조기량（8ml/kg）+10cmH2OPEEP조，각15례。전마후안요구설치호흡삼수행궤계통기。술중지속감측병인호흡삼수，분별우궤계통기30min（T1）、1h(T2)、2h(T3)、3h(T4)급발관후1h(T5)측동맥혈기일차。병우유도전(T0)、통기3h(T4)、발관후1h(T5)급술후24h(T6)점채뇨동맥혈2ml，측정SP-D농도。결과3조병인폐포동맥혈양분압차（A-aDo2）조내비교，T5시각교T1、T2、T3、T4고；조간비교，재T2、T3、T4、T5시L3조적A-aDo2교기타량조도저，차이유통계학의의。혈청SP-D농도，조내비교，L1조화L2조재T6시간점교T0、T4급T5시승고；조간비교，재T6시각，L3조적교L1조L2조강저，차이유통계학의의。결론복합10cmH2OPEEP적소조기량궤계통기가방지폐불장급폐손상적발생，경괄합우위장수술환자。
Objective To study the effects of low tidal volume ventilation with different PEEP on patients udergoing elective gastrointestinal surgery. Methods 45 patients were randomly divided into 3 groups:Group L1 (Low tidal volume without PEEP), Group L2 (low tidal volume with 5cm H2O PEEP),and Group L3 (low tidal volume ventilation with 10cm H2O PEEP),VT=8ml/kg,f=14times/min. After intubation all patients were mechanically ventilated. Respiratory parameters should be measured continuously during the surgery. The blood gas analysis was measured at 30 minutes after ventilation (T1),1 hour after ventilation (T2),2 hours after ventilation(T3),3 hours after ventilation(T4) and 1hour after extubation(T5). Blood samples were collected from peripheral artery at different time points including before induction(T0),3 hours after ventilation(T4),1 hour after extubation (T5) and 24 hours after operation (T6). The serums were stored in refrigerator at -70℃ and the SP-D in the serums were quantified by ELISA. Results The A-aDo2 of the three Groups at T5 is higher than at T1、T2、T3 and T4. While the A-aDo2 of Group L3 is less than Group L1 and Group L2 at T2、T3、T4 and T5. The SP-D in the serums of Group L1 and Group L2 at T6 is higher than at T0、T4 and T5. The SP-D of Group L3 is less than Group L1 and Group L2 at T6. Conclusion the low tidal volume ventilation with 10cmH2o PEEP is more suit-able for patients udergoing elective gastrointestinal surgery according to its prevence of atelectasis and lung injury.
