保护性通气策略对OSASH病人呼吸循环功能的影响

EFFECTS OF PROTECTIVE VENTILATION ON RESPIRATORY AND CIRCULATORY FUNCTION IN OSASH PATIENTS

目的:探讨保护性通气策略对阻塞性睡眠呼吸暂停低通气综合征(Obstructive sleep apnea-hypopnea syndrome,OSAHS)病人术中呼吸循环功能的影响。方法:选取我院2016-01~2016-12择期行腭咽成型术的病人40例,术中依据不同机械通气模式采用随机数字表法分为两组,每组20例,A组采用间歇正压通气(IPPV),VT=10m L/kg,f=10~12次/min;B组采用IPPV加PEEP(5cm H_2O),VT=6m L/kg,f=12~15次/min,术中根据呼气末二氧化碳分压(PetCO_2)调整呼吸频率。记录入室(T1)、麻醉插管后20 min(T_2)、拔管后20 min(T_3)的动脉氧分压(Pa O2)、动脉血二氧化碳分压(PaCO_2)、肺泡-动脉氧分压差(A-aDO_2)、气道峰压(Ppeak)、平均气道压(Pmean)、动态肺顺应性(Cdyn)以及MAP、HR。结果:与A组相比,T3时B组PaO_2明显升高(P<0.05),AaDO_2明显降低(P<0.05),T2时Cdyn明显升高(P<0.05),其他各时点A、B两组呼吸参数组内、组间比较差异无统计学意义,循环方面与A组比较,B组各时点HR和MAP差异无统计学意义(P>0.05),术后B组病人低氧血症、高碳酸血症较A组发生率低(P<0.05),肺感染与肺不张的发生率差异无统计学意义(P>0.05)。结论:保护性通气策略对全麻下OSASH病人的呼吸功能具有改善作用,对病人血流动力学参数的影响不明显,应在临床上常规应用。

Objective： To study the effect of protective ventilation strategy on the respiratory function and circulation during obstructive sleeping apnea hypopnea syndrome（ OSAHS） patients under UPPP surgery.Methods： 40 OSAHS patients under general anesthesia with ASA classⅠorⅡ from January 2016 to December 2016 were enrolled and random Ly divided into two intraoperative mechanical groups,20 cases in each group,A group using intermittent positive pressure ventilation（ IPPV）,VT =10 m L/kg,f = 10～12/min in group; B group using IPPV and PEEP（ 5 cm H2 O）,VT = 6 m L/kg,f = 12～15/min,according intraoperative Pet CO_2（ Pet CO_2） respiratory to adjustment frequency.Recording enter operation room（ T1）,20 minutes after intubation（ T_2）,20 minutes after extubation（ T3） arterial oxygen pressure（ PaO_2）,arterial partial pressure of carbon dioxide（ PaCO_2）,Alveolar arterial oxygen difference（ A-a DO_2）,peak airway pressure（ Ppeak）,mean airway pressure（ Pmean） and dynamic lung compliance（ Cdyn）,MAP,HR. Results： Compared with A group,T_3B group PaO_2 increased significantly（ P〈0.05）,A-a DO_2 decreased significantly（ P〈0.05）,T_2 Cdyn（ P〈0.05）,there were no statistically significant differences in the respiratory parameters between the two groups at other time points,There were no statistically significant differences in HR and MAP between the B groups（ P〈0.05） at each time point（ B ） The incidence of hypoxemia and hypercapnia in group B was lower than that in group A（ P〉 0.05）. There was no significant difference in the incidence of pulmonary atelectasis and pulmonary infection（ P〉 0.05）. Conclusion： The protective ventilation strategy has an improved effect on the respiratory function of OSASH patients under general anesthesia,and the effect on the hemodynamic parameters of patients is not obvious.It should be popularized in clinical application.