[关键词]
[摘要]
目的: 探讨保护性通气策略对阻塞性睡眠呼吸暂停低通气综合征( Obstructive sleep apnea-hypopnea
syndrome,OSAHS) 病人术中呼吸循环功能的影响。方法: 选取我院2016-01~ 2016-12 择期行腭咽成型术的病人
40 例,术中依据不同机械通气模式采用随机数字表法分为两组,每组20 例,A 组采用间歇正压通气( IPPV) ,VT
= 10mL/kg,f = 10~ 12 次/min; B 组采用IPPV 加PEEP( 5cm H2O) ,VT= 6mL/kg,f = 12~ 15 次/min,术中根据呼气
末二氧化碳分压( PetCO2) 调整呼吸频率。记录入室( T1) 、麻醉插管后20 min( T2) 、拔管后20 min( T3) 的动脉氧
分压( PaO2) 、动脉血二氧化碳分压( PaCO2) 、肺泡-动脉氧分压差( A-aDO2) 、气道峰压( Ppeak) 、平均气道压
( Pmean) 、动态肺顺应性( Cdyn) 以及MAP、HR。结果: 与A 组相比,T3 时B 组PaO2明显升高( P< 0.05) ,AaDO2
明显降低( P<0.05) ,T2 时Cdyn 明显升高( P<0.05) ,其他各时点A、B 两组呼吸参数组内、组间比较差异无
统计学意义,循环方面与A 组比较,B 组各时点HR 和MAP 差异无统计学意义( P>0.05) ,术后B 组病人低氧血
症、高碳酸血症较A 组发生率低( P<0.05) ,肺感染与肺不张的发生率差异无统计学意义( P>0.05) 。结论: 保护
性通气策略对全麻下OSASH 病人的呼吸功能具有改善作用,对病人血流动力学参数的影响不明显,应在临床上
常规应用。
[Key word]
[Abstract]
Objective: To study the effect of protective ventilation strategy on the respiratory
function and circulation during obstructive sleeping apnea hypopnea syndrome( OSAHS) patients under
UPPP surgery.Methods: 40 OSAHS patients under general anesthesia with ASA classⅠorⅡ from January
2016 to December 2016 were enrolled and randomLy divided into two intraoperative mechanical
groups,20 cases in each group,A group using intermittent positive pressure ventilation( IPPV) ,VT =
10mL /kg,f = 10~12 /min in group; B group using IPPV and PEEP( 5cm H2O) ,VT = 6mL /kg,f = 12~
15 /min,according intraoperative PetCO2( PetCO2) respiratory to adjustment frequency.Recording enter
operation room( T1) , 20 minutes after intubation( T2) , 20 minutes after extubation( T3) arterial oxygen
pressure( PaO2 ) ,arterial partial pressure of carbon dioxide ( PaCO2) ,Alveolar arterial oxygen
difference( A-aDO2) ,peak airway pressure( Ppeak) ,mean airway pressure( Pmean) and dynamic lung
compliance( Cdyn) ,MAP,HR.Results: Compared with A group,T3 B group PaO2 increased significantly(
P<0.05) ,A-aDO2 decreased significantly( P<0.05) ,T2 Cdyn( P<0.05) , there were no statistically
significant differences in the respiratory parameters between the two groups at other time points,
There were no statistically significant differences in HR and MAP between the B groups( P>0.05) at
each time point( B>) The incidence of hypoxemia and hypercapnia in group B was lower than that in
group A( P<0.05) .There was no significant difference in the incidence of pulmonary atelectasis and
pulmonary infection( P>0.05) .Conclusion: The protective ventilation strategy has an improved effect
on the respiratory function of OSASH patients under general anesthesia,and the effect on the hemodynamic
parameters of patients is not obvious.It should be popularized in clinical application.
[中图分类号]
R562
[基金项目]
收稿日期: 2017-03-11; 修回日期: 2017-08-16
基金项目: 内蒙古自然科学基金( kjt 14 ms873) ; 内蒙古医科大学附属医院面上项目( NYFY YB2014014)
作者简介: 钟海燕( 1973-) ,女,内蒙古医科大学附属医院麻醉科主任医师,医学硕士。