小潮气量联合呼气末正压肺保护通气对全身麻醉老年患者心输出量的影响

Influence of Low-tidal Volume and Positive End Expiratory Pressure Protective Ventilation on Cardiac Output Volume in Elderly Patients under General Anesthesia

目的研究小潮气量联合呼气末正压(PEEP)通气对全身麻醉老年患者心输出量的影响。方法将2012年8月-2014年7月择期行腹部手术的老年患者60例分成3组,每组20例。A组为常规通气组:潮气量8 m L/kg,PEEP 0 cm H2O(1 cm H2O=0.098 k Pa);B组:潮气量6 m L/kg,PEEP 5 cm H2O;C组:潮气量6 m L/kg,PEEP 8 cm H2O。观察各组麻醉诱导前(T0)、麻醉诱导后机械通气15 min(T1)、麻醉诱导后60 min(T2)、气管拔管后15 min(T3)的血压、心率、心输出量、动脉血气、气道平均压。结果 3组术中平均动脉压、心输出量稳定;更改呼吸模式后,B组、C组中心静脉压升高显著,气道平均压升高,肺顺应性增大,动脉血气氧分压增加(P<0.05)。结论小潮气量联合5 cm H2O、8 cm H2O PEEP肺保护通气对全身麻醉老年患者心输出量影响小,可以安全用于临床。

Objective To study the inl uence of low-tidal volume and positive end expiratory pressure（PEEP） protective ventilation on cardiac output volume in elderly patients under general anesthesia.Methods From August 2012 to July 2014,60 elderly patients undergoing selective surgery were divided into three groups with 20 patients in each.Group A was treated with conventional ventilation： tidal volume at 8 m L/kg,PEEP at 0 cm H2O（1 cm H2O=0.098 k Pa）; group B was treated with a tidal volume of 6 m L/kg and a PEEP of 5 cm H2O; group C was treated with a tidal volume of 6 m L/kg and a PEEP of 8 cm H2 O.We then observed and analyzed the blood pressure,heart rate,cardiac output,arterial blood gas and airway mean pressure before induction of anesthesia（T0）,15 minutes of mechanical ventilation at er the induction of anesthesia（T1）,60 minutes at er anesthesia induction（T2）,and 15 minutes at er tracheal extubation（T3）.Results In all the three groups,the mean arterial pressure and cardiac output were stable.In group B and C,central venous pressure increased signii cantly,the mean airway pressure and lung compliance increased,and the arterial oxygen branch pressure also increased signii cantly（P〈 0.05）.Conclusion Low-tidal volume combined with 5-cm H2 O or 8-cm H2 O positive end expiratory pressure lung-protective ventilation had a small inl uence on the cardiac output of elderly patients under anesthesia,which can be safely used.