2种潮气量对超重或肥胖患者全麻机械通气的影响

Influence of two tide volumes on general anesthesia and mechanically ventilate in patients with over weight or obesity

目的研究2种不同潮气量对超重或肥胖患者机械通气效果的影响,寻求一种能使超重或肥胖患者避免过度通气和降低通气相关性肺损伤(VILI)发生风险的理想通气模式。方法 80例超重或肥胖拟择期非心脏手术患者随机分成4组:男性对照组、男性实验组、女性对照组、女性实验组。各组均采用3 mg/L丙泊酚复合3μg/L瑞芬太尼靶控静脉输注,0.3 mg/kg顺阿曲库铵诱导,同时纯氧(4 L/min)辅助呼吸。喉镜明视下气管插管,按各组VT调节潮气量,R 11次/min,I∶E=1∶2;50%氧气-空气2 L/min机械通气。3 mg/L丙泊酚复合3μg/L瑞芬太尼持续靶控输注;0.1 mg/kg顺阿曲库铵间断静注。分别于机械通气开始(S)、机械通气后1 h(1 h)、手术结束前(E)以及复苏拔管前(R)作血气分析,并分别监测气道压力(PAW)和计算氧合指数。结果①对照组潮气量(VT)与实验组比较有显著性差异(P<0.05),男性对照组VT比实验组大20%,女性对照组VT比实验组大13%。②对照组机械通气开始PAW(PAWS)、机械通气1 h PAW(PAW1h)及手术结束前PAW(PAWE)与实验组比较有显著性差异(P均<0.05)。③女性对照组机械通气1 h氧合指数(OI1h)及手术结束前氧合指数(OIE)与实验组比较有显著性差异(P均<0.05)。④男性对照组的OIE<300者与实验组比较有显著性差异(P<0.05);女性对照组OIE<300者与实验组比较有显著性差异(P<0.05)。⑤对照组机械通气1 h p(CO2)(p(CO2)1 h)及手术结束前p(CO2)(p(CO2)E)与实验组比较有显著性差异(P均<0.05)。结论实验组以较小的潮气量、气道压力,能充分地维持机械通气下的肺氧合,避免过度通气,降低VILI发生的风险,是一种肺保护通气模式。

Objective It is to investigate the influence of two different tide volumes on mechanically ventilation effective-ness in over weight or obesity patients,and to explore a kind of protectived lung protection ventilation model which could avoid hyperventilation and decrease the occurred risk of ventilation-induced lung injury（ VILI）. Methods 80 patients with over weight or obesity who would be undergone selective noncardiac surgery were randomly divided into 4 groups：the male experi-ment group,the male control group,the female experiment group and the female control group. 3 mg/L propofol and 3 μg/L remifentanil were adopted to in each group patients by target control infusion respectively,during induction of anesthesia,with pure oxygen（4 L/min）being assisted respiration. Then 0. 3 mg/kg atracurium was also infused by vein in each group. After tracheal intubation,VT was adjusted to each group’s volume tide and the rate of mechanical ventilation was 11 beats/min, with 50% oxygen-air gas mixture 2 L/min. Propofol（3 mg/L）and remifentanil（3 μg/L）by also were continuously target control infused in each group during maintenance of anesthesia. 0. 1 mg/kg atracurium was injected by vein intermittently. The blood gas analysis results and air way pressure（ PAW）were respectively recorded at mechanical ventilation start（ S）,the post mechanical ventilation 1 hour（1h）,the end-operation（E）and the respiratory recovery before extubation（R）. Results①There was significant difference in VT between the control group and the experiment group（P〈0. 05）. VT in the male con-trol group was more 20% than VT in the male experiment group. VT in the female control group was more 13% than VT in the female experiment group. ②There were significant differences in PAW at the mechanical ventilation 1h（ PAW1h）,PAW at the mechanical ventilation start（ PAWS）and PAW at end-operation（ PAWE）between the control group and the experiment group（all P〈0. 05）. ③There was significant in oxygenation index at the mechanical ventilation 1h（OI1h）between the fe-male control group and the female experiment group（P〈0. 05）. ④There was significant difference in patients which OGI atend-operation（OIE）〈 300 between the female control group and the female experiment group（P〈0. 05）,and beween the male control group and the male experiment group（P〈0. 05）. ⑤ There were significant difference in arterial carbon dioxide pressure（p（CO2））at the mechanical ventilation 1hour（p（CO2）1h）and p（CO2）at end-operation（p（CO2）E）between the control group and the experiment group（all P〈0. 05）. Conclusion VT in the experiment group is a kind of less tide vol-ume and less air way pressure relatively lung protectived ventilation model than in the control group,which could avoid hyper-ventilation and decrease the occurred risk of ventilation-induced lung injury.