不同PEEP下小潮气量机械通气对胃肠手术患者肺的影响

Effects of low tidal volume ventilation with different PEEP on patients udergoing elective gastrointestinal surgery

目的研究不同PEEP值下小潮气量机械通气对胃肠手术患者肺的影响。方法 45例病例随机分成3组,L1组:小潮气量(8ml/kg)+0cm H2OPEEP,L2组:小潮气量(8ml/kg)+5cm H2OPEEP组,L3组:小潮气量(8ml/kg)+10cm H2OPEEP组,各15例。全麻后按要求设置呼吸参数行机械通气。术中持续监测病人呼吸参数,分别于机械通气30min(T1)、1h(T2)、2h(T3)、3h(T4)及拔管后1h(T5)测动脉血气一次。并于诱导前(T0)、通气3h(T4)、拔管后1h(T5)及术后24h(T6)点采桡动脉血2ml,测定SP-D浓度。结果 3组病人肺泡动脉血氧分压差(A-a Do2)组内比较,T5时刻较T1、T2、T3、T4高;组间比较,在T2、T3、T4、T5时L3组的A-a Do2较其他两组都低,差异有统计学意义。血清SP-D浓度,组内比较,L1组和L2组在T6时间点较T0、T4及T5时升高;组间比较,在T6时刻,L3组的较L1组L2组降低,差异有统计学意义。结论复合10cm H2OPEEP的小潮气量机械通气可防止肺不张及肺损伤的发生,更适合于胃肠手术患者。

Objective To study the effects of low tidal volume ventilation with different PEEP on patients udergoing elective gastrointestinal surgery. Methods 45 patients were randomly divided into 3 groups：Group L1（Low tidal volume without PEEP）,Group L2（low tidal volume with 5cm H2 O PEEP）,and Group L3（low tidal volume ventilation with 10 cm H2O PEEP）,VT=8ml/kg,f=14times/min. After intubation all patients were mechanically ventilated. Respiratory parameters should be measured continuously during the surgery. The blood gas analysis was measured at 30 minutes after ventilation（T1）,1 hour after ventilation（T2）,2 hours after ventilation（T3）,3 hours after ventilation（T4） and 1hour after extubation（T5）. Blood samples were collected from peripheral artery at different time points including before induction（T0）,3 hours after ventilation（T4）,1 hour after extubation（T5） and 24 hours after operation（T6）. The serums were stored in refrigerator at-70℃ and the SP-D in the serums were quantified by ELISA. Results The A-a Do2 of the three Groups at T5 is higher than at T1、T2、T3and T4. While the A-a Do2 of Group L3 is less than Group L1 and Group L2 at T2、T3、T4and T5. The SP-D in the serums of Group L1 and Group L2 at T6is higher than at T0、T4and T5. The SP-D of Group L3 is less than Group L1 and Group L2 at T6. Conclusion the low tidal volume ventilation with 10 cm H2o PEEP is more suitable for patients udergoing elective gastrointestinal surgery according to its prevence of atelectasis and lung injury.