不同机械通气模式对老年腹部手术患者呼吸力学及血流动力学的影响

Influence of respiratory mechanics and hemodynamics by different ventilation patterns in elderly patients undergoing abdominal operation

目的 探讨不同机械通气模式对老年腹部手术患者围术期呼吸力学及血流动力学的影响.方法 选择2012年1～10月深圳市第二人民医院择期行腹部手术全麻机械通气的老年患者（年龄＞65岁）48例,随机分为4组,每组各12例,A0组：容量控制通气（VCV）＋自动变流（auto flow）模式;C0组：VCV＋恒定送气流速（const flow）模式;A8组：VCV＋呼气末正压（PEEP）8 mm Hg＋auto flow模式;C8组：VCV＋PEEP 8 mm Hg＋const flow模式.监测每分钟通气量（MV）、气道吸气峰压（APIP）、气道阻力（Raw）、胸肺顺应性（C）、平均动脉压（MAP）、心率（HR）、动脉血氧分压（PaO2）等呼吸力学及血流动力学指标并进行统计学分析比较.结果 ①各组患者在应用VCV＋const flow模式通气60 min时,APIP、Raw、C、MAP、HR及PaO2比较差异均无统计学意义（P＞0.05）.②各组患者在应用各自通气模式4h后,A0组与C0组比较或A8组与C8组比较,APIP和Raw显著降低,C有显著增加,差异均有统计学意义（P＜ 0.05）;A8组Raw低于其他3组,差异有统计学意义（P＜0.05）;而MAP、HR各组差异无统计学意义（P＞0.05）.A8组与A0、C0组比较,或C8组与A0、C0组比较,PaO2显著增加,差异有统计学意义（P＜0.05）.结论 老年腹部手术患者全身麻醉应用VCV＋const flow＋ PEEP 8 mm Hg通气模式,可以降低气道峰压和气道阻力,改善胸肺顺应性,同时提高动脉血氧分压有利于组织供氧,可能有助于预防机械通气所致的肺损伤.

Objective To discuss the influence of cardiac-pulmonary function on elderly patients undergoing abdominal operation using different ventilation patterns.Methods 48 elderly patients （aged ＞65） undergoing abdominal operation and general mechanical ventilation from January to October 2012 in the Second People＇s Hospial of Shenzhen City were selected and divided into 4 groups randomly with 12 cases in each group; group A0 was treated with volume control ventilation （VCV）＋ auto flow model,group C0 was treated with VCV＋ const flow model; group A8 was treated with VCV＋end expiratory positive pressure （PEEP） 8 mm Hg＋auto flow model; group C8 was treated with VCV＋PEEP 8 mm Hg＋const flow model.MV,APIP,raw air way resistance （Raw）,lung compliance （C）,MAP,HR,PaO2 were analyzed and compared.Results ①The differences of APIP,R,C,MAP,HR,PaO2 in each group 60 min under VCV＋const flow model were not statistically significant （P ＞ 0.05）.②APIP,Raw reduced,C increased 4 hours under their respective ventilation mode when group A0 compared with group CO,group A8 compared with group C8,the differences were statistically significant （P ＜ 0.05）; the Raw in group A8 was lower than other 3 groups,the differences were statistically significant （P ＜ 0.05）; the difference of MAP,HR in each group was not statistically significant （P ＞ 0.05）.PaO2 increased when group A8 compared with group A0 and C0,group C8 compared with A0 and C0,the differences were statistically significant （P ＜ 0.05）.Conclusion For the elderly patients undergoing abdominal operation,using the ventilation pattern of VCV＋const flow＋PEEP 8 mm Hg can reduce the peak inspiratory pressure and the airway resistance significantly,also can improve the pulmonary compliance and increase arterial partial pressure of oxygen,and also maybe can take precautions against ventilator-induced lung injury.