不同潮气量对体重超重或肥胖患者肺氧合功能的影响

目的分析不同潮气量对体重超重或肥胖患者机械通气肺氧合功能的影响,探索一种肺保护通气模式。方法选取体重超过重或肥胖拟择期非心脏手术患者80例,将其随机分成男性实验组、女性实验组、男性对照组、女性对照组。两组均采用丙泊酚复合瑞芬太尼靶控静脉输注,顺阿曲库铵诱导。喉镜明视下气管插管后,对照组的潮气量:潮气量=体重(kg)×8 ml/kg,实验组潮气量=平均体重指数×身高(m)2×8 ml/kg,R11次/min,I∶E=1∶2,行机械通气。丙泊酚复合瑞芬太尼持续靶控输注;顺阿曲库铵间断静注。分别在机械通气开始、机械通气后1 h作血气分析。结果①实验组潮气量低于对照组(P0.05)。②实验组机械通气1 h氧合指数(1 h OI)高于对照组(P0.05);男性对照组1 h OI300发生率高于实验组(分别是9例,2例,P0.05),女性对照组机械通气1 h OI300发生率高于实验组(分别是8例,1例,P0.05)。③实验组机械通气1 h二氧化碳分压(1 h PaCO2)高于对照组(P0.05)。结论较小的潮气量可明显减少肺氧合功能障碍发生的风险,是一种有效地肺保护通气模式。

The effect of tidal volume on pulmonary oxygenation in overweight or obese patients

Objective To study the effect of different tidal volume mechanical ventilation on pulmonary oxygenation in overweight or obese patients and explore the lung - protective ventilation mode. Methods Eighty overweight or obese patients who were scheduled for no cardiac surgery were randomly divided into four groups. Tidal volume （VT） in control group was equal to weight （kg） × 8 ml/kg, the VT in experimental group was equivalent to mean body mass index x height （m）2 × 8 ml/kg. All patients received target controlled infusion by 3μg,/ml propofol and 3 ng/ml remifentanil. Then intermittent infused cisatracurium. After anesthesia induction, VT was adjusted to preset tide volume and the rate of mechanical ventilation was 11 beats/min, with 50% oxygen - air gas mixture. Blood gas analysis and monitoring of airway pressure （PAW） were respectively done at the beginning of mechanical ventilation and one hour after mechanical ventilation. Results （1） There was significant difference in tidal volume between control group and experimental group （ P 〈 0.05 ）. （2） Significant difference was observed in oxygenation index at 1 h of mechanical ventilation （ I h OI） between control group and experiment group （ P 〈0.05 ）. The number of cases with 1 h OI 〈 300 in men in control group and experimental group were 9 and 2, respectively （ P 〈 0.05 ） ; and the number of cases with 1 h OI 〈 300 in women in control group and experimental group were 8 and 1, respectively （ P 〈 0.05 ）. （3） Significant difference was observed in partial pressure of carbon dioxide at 1 h of mechanical ventilation （ 1 h PaCO2 ） between control group and experiment group （ P 〈 0.05 ）. Conclusion Lower tidal volume mechanical ventilation may reduce intra - operative oxygenation dysfunction and is a lung - protective ventilation mode.