全身麻醉机械通气中精准设定潮气量对保持生理酸碱平衡的研究

Study of the precise set of tidal volume to maintain the balance of physiological acid and alkali in general anesthesia mechanical ventilation

目的通过在全身麻醉机械通气中设置不同的潮气量,应用血气分析对患者的酸碱状况进行研究,旨在为完善全身麻醉通气策略、精准设定潮气量提供依据。方法选择择期行神经外科肿瘤切除手术的患者60例,男性28例,女性32例,平均年龄(42±11)岁,平均体质量(65±8)kg,随机分为2组(每组30例),Ⅰ组:潮气量7 mL/kg组;Ⅱ组:潮气量9 mL/kg组。分别于麻醉诱导前即刻(T1)、全身麻醉气管插管后50~80 min(T2)和120~200 min(T3)时段麻醉深度稳定时取桡动脉血1 mL行血气分析,记录酸碱平衡主要指标:血液酸碱度(p H值)、二氧化碳分压(PaCO_2)值及HCO_3-值。结果 p H值、PaCO_2值及HCO_3-值:Ⅰ组在T1、T2、T3,Ⅱ组T1的组内、组间比较差异无统计学意义(P>0.05);Ⅱ组在T2、T3与Ⅱ组T1及Ⅰ组T2、T3比较,差异有统计学意义(P<0.01)。结论全身麻醉过程中,潮气量7 mL/kg、呼吸频率12次/min可使血液酸碱平衡保持在正常生理状态。

Objective To provide a basis for improving the general anesthesia ventilation strategy and accurate set tidal volume by establishing different tidal volume during the general anesthesia mechanical ventilation and using bloodgas analysis to study the acid and alkali status of patients. Methods Sixty patients, 28 males and 32 females with an average age of （42±11 ） years and an average body weight of （65±8） kg undergoing general anesthesia in nearosurgery were randomly divided into two groups （n=30）, group Ⅰ ： tidal volume of 7 mL/kg group; group Ⅱ： tidal volume of 9 mL/kg group. The main indexes were as follows： pH （blood pH）, PaCO2 （partial pressure of carbon dioxide） and HCO3^- value. Collect arterial blood 1mL for blood-gas analysis before anesthesia induction （T1）, 50-80 min （T2） and 120-200 min （T3） after tracheal intubation and record the values. Results The difference of pH value, PaCO2 value and HCO3 value between group Ⅰ （T1, T2, T3） and Ⅱ （T1） were not statistically significant （P〉0.05）. The difference of between the levels of Ⅱ （T2, T3） and Ⅱ（T1） and Ⅰ （T2, T3） between was statistically significant （P〈0.01）. Conclusion Tidal volume of 7 mL/kg, respiratory rate of 12 times/rain can maintain blood acid-alkali balance as the normal physiological state during general anesthesia.