摘要
目的评价麻醉诱导期持续气道正压(CPAP)通气对老年患者围术期肺不张及氧合功能的影响。方法选取择期全麻下行脑血管介入术老年患者46例,年龄65~80岁,性别不限,BMI 19~28 kg/m^(2),ASA分级Ⅱ或Ⅲ级,采用随机数字表法分为2组(n=23):对照组(C组)和CPAP通气组(CPAP组)。麻醉诱导期,CPAP组在自主呼吸时设定CPAP为5 cmH2O;当自主呼吸消失改为压力控制通气(PCV)时设定PEEP为5 cmH_(2)O。C组未设置CPAP;当自主呼吸消失行PCV时设定PEEP为0 cmH_(2)O。麻醉维持期2组均采用PCV-VG模式,设定PEEP为5 cmH_(2)O。分别于桡动脉穿刺置管后即刻(T_(0))、气管插管后1 min(T_(1))和手术结束气管拔管前(T_(2))行全肺CT扫描,计算右膈上1 cm层面肺不张面积百分比。分别于T_(0)、T_(1)、T_(2)和进入PACU 30 min(T_(3))时,采取桡动脉血样行血气分析,记录PaO_(2)和PaCO_(2),计算氧合指数(OI)。结果与T_(0)时比较,2组T_(1)和T_(2)时肺不张面积百分比升高(P<0.05);2组T_(1)和T_(2)时PaO_(2)升高,T_(3)时降至T_(0)水平,T_(1)和T_(2)时OI降低,T_(3)时升至T_(0)水平(P<0.05)。与C组比较,CPAP组T_(1)和T_(2)肺不张面积百分比降低,PaO_(2)和OI升高(P<0.05)。2组各时点PaCO_(2)比较差异无统计学意义(P>0.05)。结论麻醉诱导期CPAP通气可减少老年患者围术期肺不张的形成,提高氧合功能。
Objective To evaluate the effect of continuous positive airway pressure(CPAP)ventilation during induction of anesthesia on perioperative atelectasis and oxygenation in elderly patients.Methods Forty-six elderly patients of either sex,aged 65-80 yr,of American Society of Anesthesiologists Physical Status classificationⅡorⅢ,undergoing elective cerebrovascular intervention surgery under general anesthesia,were divided into 2 groups(n=23 each)according to the random number table method:control group(group C)and CPAP ventilation group(group CPAP).During induction of anesthesia,CPAP was set at 5 cmH_(2)O during spontaneous breathing,and PEEP was set at 5 cmH_(2)O when spontaneous breathing disappeared,and the ventilation mode was changed to pressure-controlled ventilation(PCV)mode in group CPAP.CPAP was not set,and PEEP was set at 0 cmH_(2)O for PCV when spontaneous breathing disappeared in group C.During anesthesia maintenance,PCV-volume guaranteed mode was used in both groups,and PEEP was set at 5 cmH2O.Whole lung CT scanning was performed immediately after radial artery catheterization(T_(0)),at 1 min after endotracheal intubation(T_(1)),and before tracheal extubation(T_(2))at the end of operation to calculate the percentage of atelectasis area at 1 cm above the right diaphragm.At T_(0),T_(1),T_(2) and 30 min after entering postanesthesia care unit(T_(3)),blood samples from the radial artery were taken to record PaO_(2) and PaCO_(2) and calculate the oxygenation index(OI).Results Compared with the baseline at T_(0),the percentage of atelectasis area was significantly increased at T_(1) and T_(2) in two groups(P<0.05);PaO_(2) was significantly increased at T_(1) and T_(2) and decreased to T_(0) level at T_(3),OI was decreased at T_(1) and T_(2) and increased to T_(0) level at T_(3) in two groups(P<0.05).Compared with group C,the percentage of atelectasis area was significantly decreased and PaO_(2) and OI were increased at T_(1) and T_(2) in group CPAP(P<0.05).There was no significant difference in PaCO_(2) at ea
作者
张娓娓
贺晓鹏
冯劭一
苏学森
苑昕
王少帅
王子轩
朱佳羽
王鑫
张文颉
田首元
Zhang Weiwei;He Xiaopeng;Feng Shaoyi;Su Xuesen;Yuan Xin;Wang Shaoshuai;Wang Zixuan;Zhu Jiayu;Wang Xin;Zhang Wenjie;Tian Shouyuan(School of Anesthesiology,Shanxi Medical University,Taiyuan 030000,China;The First Clinical Medical College,Shanxi Medical University,Taiyuan 030000,China;Department of Anesthesiology,First Hospital of Shanxi Medical University,Taiyuan 030000,China;Department of Neurology,First Hospital of Shanxi Medical University,Taiyuan 030000,China;Clinical College of the Third Center,Tianjin Medical University,Tianjin 300170,China;The Fourth Clinical Medical College of Capital Medical University,Beijing 100069,China;Shanxi Province Cancer Hospital Shanxi Hospital Affiliated to Cancer Hospital,Chinese Academy of Medical Sciences Cancer Hospital Affiliated to Shanxi Medical University,Taiyuan 030013,China)
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2023年第3期288-292,共5页
Chinese Journal of Anesthesiology
关键词
持续气道正压通气
老年人
肺不张
氧合
Continuous positive airway pressure
Elderly
Pulmonary atelectasis
Oxygenation
