围术期呼吸力学连续气道监测的研究

Continuous airway monitoring of respiratory mechanics during operation

目的：探讨围术期连续气道监测（ＣＡＭ）的作用及成人、小儿异常通气的特点。方法：采用旁气流（ＳＳＳ）技术以ＤａｔｅｘＵｌｔｉｍａＳＶ／Ｖ监测仪，用Ｄ－ｌｉｔｅ管（９．０×１．５ｃｍ或７．２×１．２ｃｍ）行ＣＡＭ，观察２０２例（ＡＳＡⅡ～Ⅳ）手术患者，年龄２～８９岁，体重９～８５ｋｇ；记录不同模式通气时ＣＡＭ的各种参数或图像。结果：（１）ＣＡＭ在人工通气患者中异常情况的检出率达１１．４％；其中临床医师未发现，ＣＡＭ首先显示异常情况达６９．６％；与同类手术未用ＣＡＭ相比有明显差异（Ｐ＜０．０１）；（２）异常通气时ＣＡＭ中ＰＶ环和ＦＶ环的变化特点小儿和成人一样。结论：ＣＡＭ对了解成人和小儿麻醉和手术对肺和气道力学的相互影响，对通气异常的诊疗，对减少并发症提高围术期患者的安全性起着积极地作用。

Objective:To investigate the effects of continuous airway monitoring(CAM) in airway mechanics and the characteristics of abnormal ventilation in adult and paediatric.Method:202 patients(ASA grade Ⅱ Ⅳ)were observed with technique of side stream spirometer(SSS)during operation,whose ages were ranged from 2 to 89 years old and weights were varied from 9 to 85 kg.All parameters and illustrations of various modes of mechanical ventilation were recorded with Datex Ultima SV/V monitor,the D liter tube with different sensors:9.0×1.5 cm tube used in adults and 7.2×1.2 cm tube in paediatrics.Result: The detected rate of abnormal mechanical ventilation was 11.4% by CAM,of which 69.6% was undiscovered by the doctor.The safty of the patients with CAM was increased more than that of the patients without CAM during mechanical vantilation.There was significant difference in the rate between patients with CAM and without CAM(P<0.01);The changes of pressure volume loop and flow volume loop in adults and paediatrics were similar.Conclusion:The CAM is such a effective and optional monitoring technique as to improve the diagnosis and treatments,eliminate the complications,and enhance the safty of the patients during the operation.