摘要
目的评价呼气末正压通气(PEEP)同时头高足低15～20°俯卧位对伴有吸入性肺损伤的烧伤患者全身麻醉中呼吸功能的影响。方法选择伴有不同程度吸入性肺损伤,并带有气管插管或气管切开造口,拟择期行扩创和自体皮取植术的患者45例,性别不限,年龄20～48岁,美国麻醉医师学会(ASA)分级Ⅲ或Ⅳ级,随机分为3组,每组15例。俯卧组以间歇正压通气(IPPV)模式水平俯卧位通气,PEEP俯卧组以IPPV+PEEP模式水平俯卧位通气,PEEP头高足低俯卧组以IPPV+PEEP模式头高足低15～20°俯卧位通气,3组麻醉维持均控制流量在2L/min,吸入氧气体积分数为0.8,潮气量为8～10mL/kg,呼吸频率为12次/min,PEEP值为5cmH2O(1cmH2O=0.098kPa)。分别记录患者入手术室脱氧呼吸5min及麻醉诱导前吸氧3min时的脉搏血氧饱和度(SpO2)和呼气末二氧化碳分压(petCO2)。麻醉诱导后5min及俯卧位后5、30、60、120min,记录患者的SpO2、petCO2、气道峰压(ppeak)、气道平台压(pplat)、肺动态顺应性(Cdyn)的情况。检测患者入手术室脱氧呼吸5min及俯卧位60、120min时动脉血氧分压(paO2)和动脉血二氧化碳分压(paCO2)。结果 3组在麻醉诱导前吸氧3min和麻醉诱导后5min及俯卧位后5、30、60、120min时的SpO2均显著高于同组入手术室脱氧呼吸5min时(P值均<0.01),PEEP俯卧组和PEEP头高足低俯卧组在俯卧位后30、60、120min时的SpO2均显著高于俯卧组同时间点(P值均<0.05)。3组在麻醉诱导后5min及俯卧位后5、30、60、120min时的petCO2均显著低于同组入手术室脱氧呼吸5min时(P值均<0.01),PEEP俯卧组和PEEP头高足低俯卧组在俯卧位后60、120min时的petCO2均显著低于俯卧组同时间点(P值均<0.05)。俯卧组和PEEP俯卧组在俯卧位后5、30、60、120min时的ppeak和pplat均显著高于同组麻醉诱导后5min以及PEEP头高足低俯卧组同时间点(P值均<0.05)。俯卧组和PEEP俯卧组在俯卧位后5、30、60、120min时的Cdyn均显�
Objective To investigate the effect of positive end expiratory pressure （PEEP） with prone position （torso raised and legs lowered, 15--20） on respiratory function during general anaesthesia in burnt patients with inhalational lung injury. Methods Forty-five burnt patients with inhalational lung injury, AmericanSociety of Anesthesiologists （ASA） grade or IV＇, aged 20 48 years, were randomly divided into 3 groups （n=15）. They were treated with tracheal intubation or tracheotomy ventilation and scheduled for early excision and grafting of burn wound. In group A, intermittent positive pressure ventilation （IPPV） with flat prone position was applied. In group B, IPPV-t- PEEP with flat prone position was applied. In group C, IPPV＋ PEEP with the prone position （torso raised and legs lowered, 15--20° was applied. IPPV （oxygen flow meter： 2 L/min, fraction of inspired oxygen= 80%, tidal volume.. 8--10 mL/kg, respiratory rate= 12 bpm） was performed in all three groups during maintenance of anaesthesia. PEEP I-5 cmH20 （1 cmH20.. 0. 098 kPa） was performed in group B and C. The pulse oxygen saturation （SpO2） and end tidal carbon dioxide pressure （petCO2） were monitored when the patients were awake and spontaneous breathing with room air for 5 minutes （To） and when the patients inhaled oxygen for 3 minutes before induction of anaesthesia （T1）. And the SpO2, petCO2, peak and plat airway pressure （P,k and Pp,at）, chest wall and lung dynamic compliance （Cdyn） were recorded at 5 minutes after induction （T2） and at 5 （T3）, 30 （T4）, 60 （Ts） and 120 minutes （To） after changing position from supine to prone. Arterial blood samples were taken to detect the arterial partial pressure of oxygen （paO2） and carbon dioxide （p〈0.02） at To, Ts and T0. Results The values of SpO2 at T1, T2, T3, T4, Ts and T6 were significantly higher than that at To in all the patients （P〈0.01 ）. The values of SpO2 in group B and group C were significantly higher tha
出处
《上海医学》
CAS
CSCD
北大核心
2013年第2期92-97,共6页
Shanghai Medical Journal
关键词
呼气末正压
吸入性肺损伤
灼伤患者
俯卧位
呼吸功能
Positive end expiratory pressure Inhalational lung injury
Patients, burnt Prone position Respiratory function
