无创通气在40例乳腺患者全凭静脉麻醉呼吸管理中的应用

Explore the Effects of Noninvasive Positive Airway Pressure Ventilation(NPPV) on Patients'Breathing During Intravenous Anesthesia

目的:通过对40例全凭静脉麻醉下行乳腺外科手术病例的分析,探讨无创通气在全凭静脉麻醉呼吸管理中应用,评价其对呼吸、循环及对麻醉复苏期间的影响。方法:随机选择ASAⅠ-Ⅱ级择期乳腺手术40例,分为A、B2组,A组(20例):无创通气组,麻醉诱导后,采用BiPAP(双水平气道正压通气)无创通气辅助呼吸;B组(20例):对照组,术中保留自主呼吸,鼻导管吸氧。观察2组患者MAP、HR、Spo2、血气分析并记录手术前(T0)麻醉诱导后10分钟(T1),30分钟(T2)及手术结束后(T3)其数值。比较2组患者单位时间丙泊酚用量及麻醉复苏情况。结果:A、B2组患者在手术开始后10分钟,MAP均呈下降趋势,T1、T2时刻MAP值与T0时刻值相比明显下降,其结果具有统计学意义(P<0.05),但A组下降幅度大于B组,P<0.05有统计学意义。B组患者麻醉诱导后心率加快,A组诱导后心率减慢,A、B2组相比具有统计学意义(P<0.05)。A组患者术中(T1、T2)、术后(T3)各时间点SpO2,PaO2,PH值明显高于B组患者,有显著统计学有意义(P<0.05),PaCO2明显低于B组患者,有显著统计学意义(P<0.05)。A组患者单位时间丙泊酚用量稍大于B组,麻醉复苏期间睁眼时间,呕吐评分,苏醒时间均相似,无统计学意义。结论:手术过程中无创通气技术的应用确保了患者足够的潮气量和呼吸频率,避免了急性低氧血症和二氧化碳潴留的发生,虽A组患者血压有明显下降但仍在可接受正常范围,同时无创通气避免了有创人工气道的建立,极大减轻了患者的痛苦,也减少了术中、术后气道并发症的发生,值得在临床中推荐。

Objective：To explore the effects of noninvasive positive airway pressure ventilation（NPPV） on patients’breathing during intravenous anesthesia,by 40 clinical patients scheduled for breast surgery.Methods：40 clinical patients ASA I～ II female patients aged 25-53 years scheduled for elective mammary surgery were included in this study.All 40 patients were randomly divided into two groups：group A,apply NPPV to support patients’ventilation（n=20）;group B,transnasal oxygen supply during intravenous anesthesia（n=20）.HR,Spo2,MAP,RR and the changes of arterial blood gas were recorded before anesthesia（T0）,after anesthesia,at10min（T1）,30min（T2）,and after operation（T3）.All results were treated by Analysis of Τ test.Results：After starting operation 10 min,all patients’MAP decreased,compared T1 and T2 with T0 the descent was significantly（Ρ〈0.05）,but the range of the descent 〈 20% ;After anesthesia induction,the heart rate of group A increased but group B decreased,in each group compared with T0 the difference was significantly（Ρ〈0.05）,compared group A and B,the difference was significantly（Ρ〈0.05）;At the time of T1,T2,T3,the results Spo2,Pao2,pH of group A were much higher than group B（Ρ〈0.05）,and Paco2 of group A much lower than group B（Ρ〈0.05）.Conclusions：Application noninvasive positive airway pressure ventilation（NPPV） to support patients’breathing during intravenous anesthesia was safe and feasible,application NPPV during operation make patients have enough tidal ventilation（VT） surely,avoid hypercapnia and slight acidosis and complication of invasive airway ventilation after operation.