摘要
目的观察全身麻醉中应用小潮气量(VT)联合低水平呼气末正压通气(PEEP)对老年患者呼吸功能的影响。方法20例ASAⅠ或Ⅱ级上腹部手术老年患者,随机均分为A组和B组。A组,机械通气模式为间歇正压通气(IPPV)加5cmH2OPEEP,VT=6ml/kg,f=15次/分;B组,机械通气模式为IPPV,VT=9ml/kg,f=12次/分。观察术前(T1)、麻醉插管后30min(T2)、拔管后15min(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)、MAP、CVP及术中的气道峰压(Ppeak)。结果T3时,A组PaO2较B组明显升高(P<0.05),A组A-aDO2较B组明显降低(P<0.05)。其他各时点A、B两组PaO2、PaCO2、A-aDO2、MAP、CVP、Ppeak组间比较差异无统计学意义。结论小潮气量联合低水平PEEP通气能够有效改善老年患者术后低氧血症,减少肺部并发症,更有利于老年患者呼吸功能的恢复,对老年患者血流动力学无明显影响。
Objective To investigate the effects of low tidal volume（VT） and low level PEEP mechanical ventilation on respiratory and circulation functions in elderly patients during general anesthesia. Methods Twenty 65-80 years old patients, ASA class I or 11, undergoing upper abdominal surgery were randomly assigned into two groups with 10 cases each. Low VT and low level PEEP mechanical ventilation were applied to the patients in group A （VT = 6 ml/kg, f= 15, PEEP = 5 cmH2O）,while traditional ventilation was used in group B （VT = 9 ml/kg, f= 12, PEEP= 0）. Arterial blood samples were taken and PaO2, PaCO2, A-aDO2, MAP and CVP were recorded at the time points of before operation （T1）, 30 min after tracheal intubation （T2） and 15 min after tracheal extubation （T3）. Peak airway pressure（Ppeak） was recorded during operation. Results At T3 ,PaO2 in group A was higher than that in group B and A-aDO2 in group A was lower than that in group B. There was no significant difference in PaO2, PaCO2, A-aDO2, MAP, CVP and Ppeak at other lowesponding points between the two groups. Conclusion Low VT and low level PEEP mechanical ventilation improves arterial oxygenation and accelerates the recovery of respiratory functions in elderly patients after operation with no depression on hemodynamics.
出处
《临床麻醉学杂志》
CAS
CSCD
2008年第6期490-491,共2页
Journal of Clinical Anesthesiology
