全身麻醉中应用小潮气量联合低水平PEEP对老年患者呼吸功能的影响

Influence of low tidal volume combined with low level PEEP on respiratory function of elderly patients in general anesthesia

目的探讨小潮气量联合低水平呼气末正压通气(PEEP)用于老年患者全身麻醉中对呼吸功能的影响。方法将该院拟行上腹部手术的46例老年患者分为两组,每组各23例,对照组采取常规潮气量,观察组采取小潮气量复合3cm H2O PEEP,两组均采取间歇正压通气(IPPV)。于患者术前(T0)、麻醉插管后30min(T1)及拔管后15min(T2)时分别采集患者动脉血液行血气分析,比较两组患者各时间点的动脉氧分压(PaO2)、二氧化碳分压(PaCO2)、术中气道峰压(Ppeek)及肺泡-动脉氧分压差(A-aDO2)等指标变化。结果观察组T2时PaO2为(83.58±2.43)mm Hg,明显高于对照组,而A-aDO2为(21.50±2.12),明显低于对照组(P<0.05);观察组T1时Ppeek为(11.27±1.22)cm H2O,显著低于对照组(P<0.05)。结论全身麻醉中应用小潮气量联合低水平PEEP可有效改善老年患者术后低氧血症,有利于其呼吸功能的恢复,具有较好的临床应用价值。

Objective To investigate the influence of low tidal volume （VT ） combined with low level positive end-expiratory pressure（PEEP） on the respiratory function of elderly patients in general anesthesia .Methods 46 elderly patients scheduled for up-per abdominal surgery in our hospital were randomly divided into two groups ,23 cases in each group .The control group received the conventional tidal volume （VT ） ,while the observation group was given low VT combined with 3cm H2 O of PEEP ,both groups were given intermittent positive pressure ventilation （IPPV） .The arterial blood was collected for conducting the blood gas analysis before operation（T0 ） ,at 30 min after anesthetic intubation（T1 ） and 15 min after extubation（T2 ） .The changes of the indexes of PaO2 ,PaCO2 ,Ppeek and A-aDO2 at various time points were compared between the two groups .Results PaO2 at T2 in the observa-tion group was（83 .58 ± 2 .43） mmHg ,which was significantly higher than that in the control group ,while A-aDO2 in the observa-tion group was（21 .50 ± 2 .12） ,which was significantly lower than that in the control group（P〈0 .05）;Ppeek at T1 in the observa-tion group was（11 .27 ± 1 .22） cm H2O ,which was significantly lower than that in the control group（P〈0 .05） .Conclusion The application of low VT combined with low PEEP in general anesthesia can effectively improve postoperative hypoxemia in elderly pa-tients and is conducive to the respiratory function recovery ,which has better clinical application value .