小潮气量机械通气对正常肺功能手术患儿呼吸力学及肺氧合功能的影响

Influence of low tidal volume mechanical ventilation on respiratory mechanics and pulmonary oxygena-tion function in patients with normal lung function

目的：探讨小潮气量机械通气对正常肺功能手术患儿呼吸力学及肺氧合功能的影响。方法选取120例肺功能正常的骨科手术患儿，随机分为4组，每组30例。LV组：小潮气量7 mL/kg， LVP5组：小潮气量7mL/kg＋5cm H2O PEEP，LVP10组：小潮气量7 mL/kg＋10cm H2O PEEP，CV组：常规潮气量10mL/kg。分别于机械通气30min及1 h后采集动脉血做血气分析，监测呼吸指数、氧合指数、A-aDo2、Cs、Cd，同时记录Peak、Plate数值。结果 LVP10组中T1和T2两个时间段的Peak值和Plat值明显高于其他三组，LVP5组中Cs、Cd明显高于其他三组，LV组Cs、Cd高于CV组，LV组OI明显高于其余三组，RI明显低于其他三组，A-aDO2随着时间的延长而下降，差异均有统计学意义（P＜0.05）。结论7mL/kg小潮气量机械通气对正常肺功能患儿有肺保护作用，小潮气量复合5cm H2O低PEEP能够增加肺部顺应性，但未增加肺氧合功能。小潮气量复合10cm H2O高PEEP未发现有肺保护作用。

Objetive To study the influence of low tidal volume mechanical ventilation on the respiratory mechanics and pulmonary oxygenation function of children in operation with normal lung function. Methods To choose 120 cases of orthopedic surgery in children with normal lung function,were randomly divided into four groups,each group of 30 cases.LV group：a small tidal volume 7mL/kg,LVP5 groups：small tidal volume low peep：7＋5mL/kg cm H2O PEEP,LVP10 groups：small tidal volume high PEEP group：7 mL/kg＋10cm H2O PEEP,CV groups：conventional tidal volume 10mL/kg.After mechanical ventilation 30min and 1h,respectively,doing arterial blood gas analysis and at the same time monitoring of respiratory index,oxygenation index,A-aDo2 ,Cs,Cd record Peak,Plat. Results LVP10 group T1and T2 in the two periods of Peak values and plat,significantly higher than the other three groups,the Cs、Cd in LVP5 group was obviously higher than that of the other three groups,the Cs、Cd in LV group is higher than CV,the OI in LV group was obviously higher than that of the rest three groups,RI were significantly lower than the other three groups,as the extension of time A-aDO2 declined,the difference had statistical significance （P〈0.05 ）. Conclusion 7 mL/kg of low tidalvolume mechanical ventilation on pulmonary function in children with normal lung protection,low tidal volume compound 5cm H2O low PEEP can increase lung compliance ,but did not increase pulmonary oxygenation function.The lung protection of Low tidal volume compound 10cm H2O high PEEP has not been found .