容许性高碳酸血症在输尿管软镜钬激光碎石术麻醉中的应用效果观察

Effects of permissive hypercapnia during anesthesia for flexible ureteroscopy with holmium laser lithotripsy

目的观察和分析容许性高碳酸血症(PHC)在输尿管软镜钬激光碎石术麻醉中的应用效果。方法选取60例接受输尿管软镜钬激光碎石术患者作为研究对象,随机分为观察组和对照组,每组各30例,2组患者均采用气管内插管全麻。对照组患者术中采用小潮气量快频率通气,使患者术中二氧化碳分压(PaCO2)≤45 mm Hg;观察组患者术中采用小潮气量联合间断呼吸暂停的通气模式,使患者处于45 mm Hg<PaCO2<70 mm Hg状态。对2组患者术中的心率(HR)、平均动脉压(MAP)、血液pH值、PaCO2和血氧分压(PaO2)情况以及术后拔管时间、定向力恢复时间等麻醉复苏情况进行观察和比较。结果 2组患者的HR、MAP的组间差异和组内差异均无统计学意义(P>0.05),均控制在临床上的安全范围;2组患者的血液pH、PaCO2、PaCO2的组内差异无统计学意义(P>0.05),2组患者的PaO2在各时点的差异均无统计学意义(P>0.05),在T2至T6时点,观察组患者的血液pH值均显著低于对照组(P<0.05),而PaCO2均显著高于对照组(P<0.05),2组患者在T1和T7时点的上述指标的差异无统计学意义(P>0.05);2组患者的拔管时间、定向力恢复时间等术后麻醉复苏指标的差异无统计学意义(P>0.05)。结论在输尿管软镜钬激光碎石术麻醉中使患者维持PHC状态,不会引起患者血流动力学指标和血氧水平的明显波动,在减弱呼吸强度、确保手术效果的同时可保证患者术中安全,对患者术后麻醉复苏情况无不良影响。

Objective To observe the application effects of permissive hypercapnia（ PHC） during anaesthesia for flexible ureteroscopy with holmium laser lithotripsy. Methods Total 60 patients undergoing flexible ureteroscopy with holmium laser lithotripsy were selected as the research objects and randomly divided into the observation group and the control group with 30 cases each group. The patients in both groups underwent general anesthesia and tracheal intubation. The patients in the control group rceived low tidal volume ventilation in fast frequency so that the partial pressure of carbon dioxide（ PaCO2） was no more than 45 mm Hg; while the patients in the observation group received low tidal volume combined with intermittent ventilation apnea so that the patients was in 45 mm Hg 〈PaCO2〈 70 mm Hg state. The heart rate（ HR）,mean arterial pressure（ MAP）,blood pH,PaCO2 and partial pressure of oxygen（ PaO2） and the anaesthesia recovery condition such as postoperative time to extubation,orientation recovery time in the both groups were observed and compared.Results There were no significant differences in HR and MAP between the two groups and within the group（ P〉0. 05）,and the values were controlled in the range of the clinical security. There were no significant differences in pH,PaCO2 and PaCO2between the two groups（ P〉0. 05） and there was no significant difference in PaO2 between the two groups at each time point（ P〉0. 05）. From T2 to T6time point,the blood pH of the patients in the observation group were significantly lower than those of the control group（ P〈0. 05）,and PaCO2 of the observation group were significantly higher than those of the control group（ P〈0. 05）. The differences of the above indexes between the two groups at T1 and T7were not significant（ P〉0. 05）; There were no significant differences in postoperative anesthesia recovery indexes such as time to extubation and orientation recovery time between the two groups（ P〉0. 05）. Conclusion The maintenance of PHC during the anesthesia of flexible ureteroscopy with holmium laser lithotripsy will not cause significant fluctuations in the levels of hemodynamics indexes and oxygenation of the patients. The application can ensure the safety of patients in case the patients＇ respiration movements be weakened and the operation effects be achieved,and has no adverse effects on the recovery of patients after the anesthesia.