摘要
目的:探讨低体重患者气管插管全身麻醉机械通气时根据校正体重设置潮气量的可行性。方法:择期行四肢手术的低体重患者60例,均为平卧位手术,ASA Ⅰ~Ⅱ级,随机分成3组,每组20例;分别按8 mL/kg实际体重(ABW组)、校正体重(CBW组)和理想体重(IBW组)设置初始潮气量,呼吸频率为12次/min;观察记录气道峰压(Ppeak)、气道平台压(Pplat)和气道阻力(Raw);于机械通气后30 min抽动脉血测血气分析,记录动脉血二氧化碳分压(PaCO_2),并对PaCO_2>45 mmHg或<35 mmHg的患者重新调整潮气量;记录各组需要调整潮气量的例数、动脉血氧分压(PaO_2)并计算氧合指数,同时记录该时刻的动脉平均压和心率。结果:与CBW组相比,ABW组PaCO_2[(49.5±3.9)mmHg vs(40.0±2.5)mmHg]明显升高(P<0.01),IBW组PaCO_2[(31.5±3.9)mmHg vs(40.0±2.5)mmHg]明显降低(P<0.01);3组患者的PaO_2和OI比较差异无统计学意义(P>0.05);与CBW组(0例)相比,IBW组(14例)和ABW组(16例)调整呼吸参数的患者例数明显增加(P<0.01);与CBW组相比,IBW组Ppeak[(16.0±1.7)cm H_2O vs(14.7±1.7)cm H_2O]、Pplat[(12.4±1.6)cm H_2O vs(11.4±1.3)cm H_2O]、Raw[(16.9±2.9)cm H_2O·L^(-1)·S^(-1) vs(12.6±2.4)cm H_2O·L^(-1)·S^(-1)]明显升高(P<0.01)。结论:对于肺功能正常的低体重患者,当呼吸频率设为12次/min时,按8 mL/kg校正体重设置初始潮气量较为合适。
Objective To investigate the feasibility for setting up tidal volume based on corrected body weight in low weight patients with controlled mechanical ventilation during general anesthesia Methods Sixty ASA Ⅰ–Ⅱ low weight patients, with body mass index（IBM） range of 15–18 kg/m^2, scheduled for arms and legs surgery were enrolled in the study.Patients were divided into actual body weight group（Group ABW）, corrected body weight group（Group CBW） and ideal body weight group（Group IBW）, 20 in each group.The patients received tidal volume（8 mL/kg） based on actual body weight（Group ABW）, corrected body weight（Group CBW） or ideal body weight（Group IBW） and the respiratory rate was set at 12 bpm.The variables of Ppeak,Pplat and Raw were recorded.After mechanical ventilation of 30 min, arterial blood gas analysis was performed and PaCO2 was recorded.The patients with PaCO2 45 mmHg or 35 mmHg needed to reset ventilator parameters.The number of tidal volume needing to be adjusted, arterial oxygen partial pressure（PaO2） and oxygenation index（OI） were recorded.The mean arterial pressure and heart rate at that time were recorded.Results PaO2 and OI of three groups had no differences（P〈0.05）.Compared with Group CBW [（40.0±2.5） mmHg], the PaCO2 increased significantly in Group ABW [（49.5±3.9） mmHg]（P〈0.01） and decreased significantly in Group IBW [（31.5±3.9） mmHg（P〈0.01）.Compared with Group CBW（0 case）, the number of patients of needing reset ventilator parameters was significantly increased in Group ABW（16 cases） and in Group IBW（14 cases）（P〈0.01）.Compared with Group CBW, the Ppeak [（16.0±1.7） cm H2O vs（14.7±1.7） cm H2O], Pplat [（12.4±1.6） cm H2O vs（11.4±1.3） cm H2O], Raw [（16.9±2.9） cm H2O · L^-1·S^-1 vs（12.6±2.4） cm H2O · L^-1·S^-1] in Group IBW had a significant increase（P〈0.01）.Conclusion The tidal volume was suitable to set at 8 mL/kg corrected body weight when the respiratory rate was 12
作者
沈颖彦
徐佳
周红梅
SHEN Ying-yan;XU Jia;ZHOU Hong-mei(Department of Anesthesology,Second Affiliated Hospital of Jiaxing Universit)
出处
《中国中西医结合外科杂志》
CAS
2018年第3期298-301,共4页
Chinese Journal of Surgery of Integrated Traditional and Western Medicine
基金
浙江省医学会临床科研资金项目(2016ZYC-A74)
关键词
潮气量
低体重
校正体重
全身麻醉
Tidal volume
low weight patient
corrected body weight
general anesthesia
