老年超重患者心脏手术后机械通气潮气量的研究

The Research of Mechanical Ventilation Tidal Volume of Elderly Overweight Patients after Cardiovascular Surgery

目的探讨两种方法设置老年超重患者心脏手术后机械通气潮气量的临床效果。方法采用随机数字表法将解放军总医院2014年1-6月在全身麻醉下行心脏开胸手术后返回监护室的老年患者141例分为研究组和对照组,研究组(73例)采用8ml/kg×标准体质量来设置潮气量,对照组(68例)采用8ml/kg×实际体质量来设置潮气量。比较两组患者的潮气量、机械通气时间、并发症发生情况,术后返回监护室行机械通气后15min和拔除气管插管后20min的动脉血气指标,以及需再次调节潮气量设置的具体情况。结果研究组初始潮气量小于对照组,需再次调整潮气量参数的患者比例少于对照组(P<0.01);返回监护室机械通气15 min后,研究组二氧化碳分压(PaCO2)高于对照组(P<0.01);拔除气管插管后20min,研究组pH值小于对照组(P<0.01);对照组中需要再次调整潮气量者的体质量及初始潮气量均明显大于未调整者(P<0.05),调整后的潮气量明显小于调整前(P<0.01);两组患者均未发生肺损伤、低氧血症及高碳酸血症等并发症。结论根据标准体质量设置潮气量可有效降低老年超重患者过度通气的风险并取得较好的通气效果,同时能减轻医护人员工作量,为临床工作的改进提供了有益的尝试。

Objective To discuss the effects of using two methods to set tidal volume in mechanical ventilation of elderly overweight patients after cardiovascular surgery.Methods Totally 141 cases were randomly selected and divided into study group（n=73）and control group（n=68）.The study group was set tidal volume with 8ml/kg×standard weight,the control group was set with 8ml/kg×actual weight.The tidal volume,mechanical ventilation time,incidence of complications,arterial blood gases index in 15 min after mechanical ventilation and 20 min after trachea cannula removed,and the situation of re-set were compared.Results The initial tidal volume in study group was less than that of control group,and ratio of reset were less than that of control group（P〈0.01）.After 15 min of mechanical ventilation backing to ICU,the PaCO2 in study group was higher than control group（P〈0.01）,the pH index in study group was less than that in control group when patients been extubated 20 minutes later（P〈0.01）.The body mass of patients needed re-set tidal volume and initial tidal volume in control group were significantly higher than patients with no need to re-set（P0.05）,and the tidal volume was obviously reduced than before（P〈0.01）.There was no injury of lungs,hyoxemia and hypercapnia found in both two groups.Conclusions Setting tidal volume according to patients＇ standard weight can effectively decrease the risk of excessive ventilation and achieve good ventilation effects of elderly overweight patients,as well as reduce the workload,which is worthwhile in clinical trial.