呼气末正压通气对OSAHS患者全麻术中呼吸功能的影响

Effect of PEEP Ventilation on Respiratory Function during General Anesthesia in Patients with OSAHS

目的:探讨呼气末正压通气(PEEP)在阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者行腭咽成型术中应用的可行性。方法:选取我院2014年11月至2015年6月择期行腭咽成型术的患者40例,随机将其分为对照组和研究组,每组各20例。对照组采用常规通气,呼气末压力0 cm H2O(1 cm H2O=0.098 k Pa);研究组采用PEEP(呼气末压力压力5 cm H2O)。分别在入室(T0)、插管后(T1)、苏醒期拔管前(T2)、拔管后(T3)记录心率(HR)、平均动脉压(MAP)、血流动力学及呼吸力学指标,观察呛咳、躁动和术后不良事件的发生情况。结果:与T0比较,2组T2、T3时氧分压(Pa O2)值均下降(P<0.05);研究组随时间推移,气道峰压(Ppeak)和气道平台压力(Pplat)显著增加(P<0.01);与对照组比较,研究组T1、T2、T3的Pa O2、Ppeak及Pplat显著增加(P<0.05)。2组T1、T2、T3与T0时比较,HR、MAP均无显著性差异(P>0.05);研究组患者HR和MAP较对照组下降但无显著性差异(P>0.05)。结论:PEEP对全麻下OSAHS手术患者的呼吸功能具有改善作用,且加用PEEP对患者血流动力学参数的影响不明显,可在临床推广应用。

Objective： To explore the feasibility of end-expiratory pressure （ PEEP ） ventilation during uvulopalatopharyngoplasty （UPPP） in patients with obstructive sleeping apnea hypopnea syndrome（OSAHS）.Methods：40 OSAHS patients receiving UPPP under general anesthesia from November 2014 to June 2015 were enrolled and randomly divided into two groups：control group （PEEP =0 cmH2O） and research group （PEEP =5 cmH2O）, 20 cases in each group.HR, MAP, hemodynamic and respiratory parameters were recorded at T0 （into the operation room）, T1 （after intubation）, T2 （recovery period before extubation）, T3 （after extubation）.The occurrence of cough, agitation and postoperative adverse events were observed.Results：Compared with T0, PaO2 significantly decreased in the two groups at T2, T3 （ P〈0.05 ）; Ppeak, Pplat increased significantly in research group with the passage of time（P〈0.05）; compared with the control group, PaO2, Ppeak, Pplat significantly increased in research group at T1, T2, T3 （ P〈0.05）;compared with T0, HR and MAP had no statistical differences at T1, T2, T3 in the two groups（ P〉0.05）; MAP and HR decreased in research group compared with the control group, but the differences were not statistically significant （P〉0.05）.Conclusion： PEEP ventilation can improve respiratory function under general anesthesia without obvious influence of hemodynamic parameters in OSAHS patients.Therefore, it is worthy of clinical application.