俯卧位对不同类型手术病人全身麻醉机械通气下肺顺应性的影响

Effects of prone position on pulmonary compliance in patients receiving general anesthesia and mechanical ventilation

目的观察俯卧位对全身麻醉机械通气下不同手术类型病人肺顺应性的影响。方法选择择期行脊柱手术患者53例(其中脊柱侧弯手术病人20例,脊柱普通手术病人33例)。麻醉诱导气管插管后,间歇正压通气模式机械呼吸,潮气量6～10 ml/kg,呼吸频率12次/min。术前仰卧位通气10 min后改为手术俯卧位通气10min,分别经麻醉机采集不同潮气量时压力-容积曲线,计算肺顺应性。结果全身麻醉机械通气下,脊柱侧弯手术病人术前仰卧位肺顺应性为(33.6±10.0)ml/cmH2O,术前俯卧位的肺顺应性降低为(28.2±8.6)ml/cmH2O,术前仰卧位与俯卧位的肺顺应性之间差异有统计学意义(P<0.05);普通手术组病人术前仰卧位肺顺应性为(40.2±9.1)ml/cmH2O,其术前俯卧位肺顺应性降低为(36.1±4.2)ml/cmH2O,差异有统计学意义(P<0.05)。结论俯卧位时全身麻醉机械通气下手术病人的肺顺应性下降。

Objective To observe the effects of prone position on pulmonary pompliance in patients receiving different surgery under mechanical ventilation. Methods Fifty three patients undergoing elective orthopaedic vertebral surgeries were selected（20 patients were scoliosis and 33 patients belonged to non-scoliosis prevalent surgeries）.After the patient was induced and intubated,the patient was ventilated mechanically in an IPPV mode.Tidal volume（VT） was set as 6-10ml/kg,and the respiratory rate（RR） was 12 times per minute.Before operation,all patients were ventilated in supine position for 10 minutes,and then in prone position for 10 minutes.The data under these conditions were collected from the pressure-volume curve through the anesthesia machine.The average pulmonary compliance was calculated using the data at different tidal volume. Results The pulmonary compliance of the patients in the group of scoliosis at supine position before operation was（33.6±10.0）ml/cmH2O,at prone position was（28.2±8.6）ml/cmH2O.The difference between them has statistically significant（P0.05）.In the prevalent group,the pulmonary compliance at supine position before operation was（40.2±9.1）ml/cmH2O,and at prone position was（36.1±4.2）ml/cmH2O.The difference showed statistically significant（P0.05）. Conclusion The pulmonary compliance of the patients at prone position undergoing surgery receiving general anesthesia and mechanical ventilation decreased compared to those data at supine position.