小潮气量和呼吸暂停联合低呼气末正压通气在输尿管软镜手术中的应用

Application of low tidal volume,apnea ventilation and low PEEP in soft ureteroscope surgery

目的探讨小潮气量和呼吸暂停联合低呼气末正压通气(PEEP)在输尿管软镜手术中的临床应用价值。方法选择2016年1月-2017年1月该院收治的肾结石行输尿管软镜钬激光碎石术患者80例,随机分为两组,各40例,对照组为小潮气量(6 ml/kg)联合呼吸暂停通气组,观察组为小潮气量(6 ml/kg)、呼吸暂停联合低PEEP(5 cm H2O)组,比较初次呼吸暂停前与恢复正常呼吸后1 min内,患者心率(HR)、血压变化、血气分析结果中动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)变化及呼吸力学指标如:气道峰压(Ppeak)、平均气道压(Pmean)变化,并统计不同时间点(麻醉前、手术开始前、拔除气管导管时、拔除气管后30 min及术后24 h)肺泡-动脉氧分压差(A-aDO_2)、呼吸指数(RI)及肺动态顺应性20(CLdyn20)变化趋势。结果恢复呼吸后,观察组HR及平均动脉压(MAP)、Ppeak及Pmean与呼吸暂停前比较差异无统计学意义(P>0.05),HR慢于恢复呼吸后对照组(P<0.05),MAP低于恢复呼吸后对照组(P<0.05),观察组Ppeak及Pmean均低于恢复呼吸后对照组(P<0.05);观察组PaCO_2低于恢复呼吸后对照组(P<0.05),PaO_2高于恢复呼吸后对照组(P<0.05),拔除气管导管时、拔除气管后30 min及术后24 h,观察组A-aDO_2均明显低于对照组(P<0.05),CLdyn20优于对照组(P<0.05),RI大于对照组(P<0.05)。结论针对输尿管软镜手术,术中行小潮气量(6 ml/kg)、呼吸暂停联合5 cm H2O低PEEP处理,在确保手术顺利进行前提下,可更好地维持患者生命体征平稳、血气分析结果正常,改善机体氧供需平衡,保护患者肺功能,促进患者术后恢复。

Objective To research the application of low tidal volume,apnea ventilation and low PEEP in soft ureteroscope surgery.Methods 80 patients with renal calculi who underwent ureteroscopic holmium laser lithotripsy were randomly divided into tow groups,40 patients in each group.The observation group was treated with low tidal volume,apnea ventilation and Low PEEP,and the control group was treated with low tidal volume and apnea ventilation.Recorded the HR,MBP,PaCO2,PaO2,Ppeak,A-aDO2,and recorded A-aDO2 at pre-anesthesia,preoperation,tracheal extubation,30 min after tracheal extubation and 24 hours after surgery in tow groups.And observed the trend of RI and CLdyn in tow groups.Results There were no satistically significant differences of HR,MBP,Ppeak and Pmean after recovery and that before apnea in the observation group(P>0.05);the HR,MBP,Ppeak and Pmean of the observation group was lower than that of the control group after recovery(P<0.05);the PaO2 of the observation group was higher than that of the control group after recovery(P<0.05);at tracheal extubation,30 min after tracheal extubation and 24 hours after surgery,the A-aDO2 of the observation group was lower than that of the control group(P<0.05);the CLdyn 20 in the observation group was better than that in the control group(P<0.05).Conclusion In soft ureteroscope surgery,the application of Low tidal volume,apnea ventilation and low PEEP can ensure the asfe of operation,and maintain the vital aspect,results of blood gas analysis smoothly;and protect the lung function,promote the recovery of the patients.