不同通气容量对全身麻醉诱导胃进气的影响

The influence of different ventilating volume on gastric insuffiation in patients during anesthesia induction

目的通过超声测量评估全身麻醉诱导时不同通气容量对腹腔镜胆囊切除术（Laparoscopic cholecystectomy，LC）患者胃进气的影响。方法选择择期行LC的患者45例，年龄30～60岁，BMI19—24kg／m^2，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为3组（每组15例）：6ml／kg通气组（V6组）、7ml／kg通气组（V7组）和8ml／kg通气组（V8组）。静脉全身麻醉诱导后，采用容量控制模式行面罩通气2min。使用超声监测仪在面罩通气前及通气2min时采集胃窦部面积（cross-sectional antral area，CSA），并记录患者睫毛反射消失即刻（T0）、面罩通气30s（T1）、面罩通气60s（T2）、面罩通气90s（T3）、面罩通气2min（T4）及插管后即刻（B）的SpO2及PETCO2。结果T4、T5时V6组患者SpO2较T0及其余两组降低（P〈O．05），T3-T5时V6组患者PETCO2较T0及其余两组升高（P〈0．05）；v8组面罩正压通气后CSA明显大于面罩通气前（P〈0．05）。结论患者全身麻醉诱导去氮给氧时，面罩通气容量为7ml／kg时既可保证通气效果，又可避免发生胃进气。

Objective Evaluating the effect of different ventilation volume on gastric insufflation in patients undergoing laparoscopie cholecystectomy （LC） by ultrasonic monitoring. Methods Forty five cases of patients undergoing selective LC, aged 30-60 years old, ASA Ⅰ or Ⅱ, BMI 19-24 kg/m^2, were scheduled for selective operation under general anesthesia. They were divided into 3 groups （n=15） using a random number table： 6 ml/kg ventilation group （group V6）, 7 ml/kg ventilation group （group V7）, 8 ml/kg ventilation group （group V8）. The volume control mode was used to ventilate 2 min after the induction of intravenous general anesthesia. Some respiratory parameters （SpO2, PETCO2） were recorded at the time of loss of consciousness （T0）, after facemask pressure controlled ventilation for 30 s （T1）, 60 s （T2）, 90 s （T3）, 2 min （T4） and after tracheal intubation （T5）. The transverse section of the gastric antrum were measured respectively using ultrasound at To and T4. Results In group V6, SpO2 at T4-T5 was lower than value of To of same group and values at T4-T5 of the other two groups （P〈0.05）. PETCO2 at T3-T5 of group V6 was higher than value of To of same group and values at T3-T5 of the other two groups （P〈0.05）. The values of the cross-sectional antral areas after facemask volume controlled ventilation of group V8 were statistically significant larger than areas of group V8 before ventilation （P〈0.05）. Conclusions When the patient is induced by general anesthesia, the ventilation capacity of 7 ml/kg can guarantee the effect of ventilation and prevent the intake of gastric insufflation.