现代中西医结合杂志
現代中西醫結閤雜誌
현대중서의결합잡지
MODERN JOURNAL OF INTEGRATED TRADITIONAL CHINESE AND WESTERN MEDICINE
2014年
15期
1612-1614,1620
,共4页
邓军%韦克%黄仕英%刘敬臣%杨瑞敏
鄧軍%韋剋%黃仕英%劉敬臣%楊瑞敏
산군%위극%황사영%류경신%양서민
理想体质量%潮气量%过度通气%氧合指数%通气相关性肺损伤
理想體質量%潮氣量%過度通氣%氧閤指數%通氣相關性肺損傷
이상체질량%조기량%과도통기%양합지수%통기상관성폐손상
ideal body weight%tide volume%hyperventilation%oxygenation index%ventilation-induced lung injury
目的：研究2种不同潮气量对超重或肥胖患者机械通气效果的影响，寻求一种能使超重或肥胖患者避免过度通气和降低通气相关性肺损伤（ VILI）发生风险的理想通气模式。方法80例超重或肥胖拟择期非心脏手术患者随机分成4组：男性对照组、男性实验组、女性对照组、女性实验组。各组均采用3 mg/L 丙泊酚复合3μg/L 瑞芬太尼靶控静脉输注，0.3 mg/kg顺阿曲库铵诱导，同时纯氧（4 L/min）辅助呼吸。喉镜明视下气管插管，按各组VT调节潮气量，R 11次/min，I：E＝1：2；50％氧气-空气2 L/min 机械通气。3 mg/L 丙泊酚复合3μg/L瑞芬太尼持续靶控输注；0.1 mg/kg顺阿曲库铵间断静注。分别于机械通气开始（S）、机械通气后1 h（1 h）、手术结束前（E）以及复苏拔管前（R）作血气分析，并分别监测气道压力（PAW）和计算氧合指数。结果①对照组潮气量（VT）与实验组比较有显著性差异（P ＜0.05），男性对照组VT比实验组大20％，女性对照组 VT比实验组大13％。②对照组机械通气开始 PAW（ PAWS）、机械通气1 h PAW （PAW1h）及手术结束前PAW（PAWE）与实验组比较有显著性差异（P均＜0.05）。③女性对照组机械通气1 h氧合指数（OI1h）及手术结束前氧合指数（OIE）与实验组比较有显著性差异（P 均＜0.05）。④男性对照组的 OIE ＜300者与实验组比较有显著性差异（P＜0.05）；女性对照组 OIE＜300者与实验组比较有显著性差异（P ＜0.05）。⑤对照组机械通气1 h p（CO2）（p（CO2）1 h）及手术结束前 p（CO2）（p（CO2）E）与实验组比较有显著性差异（P均＜0.05）。结论实验组以较小的潮气量、气道压力，能充分地维持机械通气下的肺氧合，避免过度通气，降低 VILI发生的风险，是一种肺保护通气模式。
目的：研究2種不同潮氣量對超重或肥胖患者機械通氣效果的影響，尋求一種能使超重或肥胖患者避免過度通氣和降低通氣相關性肺損傷（ VILI）髮生風險的理想通氣模式。方法80例超重或肥胖擬擇期非心髒手術患者隨機分成4組：男性對照組、男性實驗組、女性對照組、女性實驗組。各組均採用3 mg/L 丙泊酚複閤3μg/L 瑞芬太尼靶控靜脈輸註，0.3 mg/kg順阿麯庫銨誘導，同時純氧（4 L/min）輔助呼吸。喉鏡明視下氣管插管，按各組VT調節潮氣量，R 11次/min，I：E＝1：2；50％氧氣-空氣2 L/min 機械通氣。3 mg/L 丙泊酚複閤3μg/L瑞芬太尼持續靶控輸註；0.1 mg/kg順阿麯庫銨間斷靜註。分彆于機械通氣開始（S）、機械通氣後1 h（1 h）、手術結束前（E）以及複囌拔管前（R）作血氣分析，併分彆鑑測氣道壓力（PAW）和計算氧閤指數。結果①對照組潮氣量（VT）與實驗組比較有顯著性差異（P ＜0.05），男性對照組VT比實驗組大20％，女性對照組 VT比實驗組大13％。②對照組機械通氣開始 PAW（ PAWS）、機械通氣1 h PAW （PAW1h）及手術結束前PAW（PAWE）與實驗組比較有顯著性差異（P均＜0.05）。③女性對照組機械通氣1 h氧閤指數（OI1h）及手術結束前氧閤指數（OIE）與實驗組比較有顯著性差異（P 均＜0.05）。④男性對照組的 OIE ＜300者與實驗組比較有顯著性差異（P＜0.05）；女性對照組 OIE＜300者與實驗組比較有顯著性差異（P ＜0.05）。⑤對照組機械通氣1 h p（CO2）（p（CO2）1 h）及手術結束前 p（CO2）（p（CO2）E）與實驗組比較有顯著性差異（P均＜0.05）。結論實驗組以較小的潮氣量、氣道壓力，能充分地維持機械通氣下的肺氧閤，避免過度通氣，降低 VILI髮生的風險，是一種肺保護通氣模式。
목적：연구2충불동조기량대초중혹비반환자궤계통기효과적영향，심구일충능사초중혹비반환자피면과도통기화강저통기상관성폐손상（ VILI）발생풍험적이상통기모식。방법80례초중혹비반의택기비심장수술환자수궤분성4조：남성대조조、남성실험조、녀성대조조、녀성실험조。각조균채용3 mg/L 병박분복합3μg/L 서분태니파공정맥수주，0.3 mg/kg순아곡고안유도，동시순양（4 L/min）보조호흡。후경명시하기관삽관，안각조VT조절조기량，R 11차/min，I：E＝1：2；50％양기-공기2 L/min 궤계통기。3 mg/L 병박분복합3μg/L서분태니지속파공수주；0.1 mg/kg순아곡고안간단정주。분별우궤계통기개시（S）、궤계통기후1 h（1 h）、수술결속전（E）이급복소발관전（R）작혈기분석，병분별감측기도압력（PAW）화계산양합지수。결과①대조조조기량（VT）여실험조비교유현저성차이（P ＜0.05），남성대조조VT비실험조대20％，녀성대조조 VT비실험조대13％。②대조조궤계통기개시 PAW（ PAWS）、궤계통기1 h PAW （PAW1h）급수술결속전PAW（PAWE）여실험조비교유현저성차이（P균＜0.05）。③녀성대조조궤계통기1 h양합지수（OI1h）급수술결속전양합지수（OIE）여실험조비교유현저성차이（P 균＜0.05）。④남성대조조적 OIE ＜300자여실험조비교유현저성차이（P＜0.05）；녀성대조조 OIE＜300자여실험조비교유현저성차이（P ＜0.05）。⑤대조조궤계통기1 h p（CO2）（p（CO2）1 h）급수술결속전 p（CO2）（p（CO2）E）여실험조비교유현저성차이（P균＜0.05）。결론실험조이교소적조기량、기도압력，능충분지유지궤계통기하적폐양합，피면과도통기，강저 VILI발생적풍험，시일충폐보호통기모식。
Objective It is to investigate the influence of two different tide volumes on mechanically ventilation effective-ness in over weight or obesity patients,and to explore a kind of protectived lung protection ventilation model which could avoid hyperventilation and decrease the occurred risk of ventilation-induced lung injury( VILI). Methods 80 patients with over weight or obesity who would be undergone selective noncardiac surgery were randomly divided into 4 groups:the male experi-ment group,the male control group,the female experiment group and the female control group. 3 mg/L propofol and 3 μg/L remifentanil were adopted to in each group patients by target control infusion respectively,during induction of anesthesia,with pure oxygen(4 L/min)being assisted respiration. Then 0. 3 mg/kg atracurium was also infused by vein in each group. After tracheal intubation,VT was adjusted to each group’s volume tide and the rate of mechanical ventilation was 11 beats/min, with 50% oxygen-air gas mixture 2 L/min. Propofol(3 mg/L)and remifentanil(3 μg/L)by also were continuously target control infused in each group during maintenance of anesthesia. 0. 1 mg/kg atracurium was injected by vein intermittently. The blood gas analysis results and air way pressure( PAW)were respectively recorded at mechanical ventilation start( S),the post mechanical ventilation 1 hour(1h),the end-operation(E)and the respiratory recovery before extubation(R). Results①There was significant difference in VT between the control group and the experiment group(P<0. 05). VT in the male con-trol group was more 20% than VT in the male experiment group. VT in the female control group was more 13% than VT in the female experiment group. ②There were significant differences in PAW at the mechanical ventilation 1h( PAW1h),PAW at the mechanical ventilation start( PAWS)and PAW at end-operation( PAWE)between the control group and the experiment group(all P<0. 05). ③There was significant in oxygenation index at the mechanical ventilation 1h(OI1h)between the fe-male control group and the female experiment group(P<0. 05). ④There was significant difference in patients which OGI at end-operation(OIE)< 300 between the female control group and the female experiment group(P<0. 05),and beween the male control group and the male experiment group(P<0. 05). ⑤ There were significant difference in arterial carbon dioxide pressure(p(CO2))at the mechanical ventilation 1hour(p(CO2)1h)and p(CO2)at end-operation(p(CO2)E)between the control group and the experiment group(all P<0. 05). Conclusion VT in the experiment group is a kind of less tide vol-ume and less air way pressure relatively lung protectived ventilation model than in the control group,which could avoid hyper-ventilation and decrease the occurred risk of ventilation-induced lung injury.
