全身麻醉不同通气模式对老年人复苏肺部并发症的影响

目的探讨研究全身麻醉下不同通气模式对老年人复苏肺部并发症的影响。方法 ASA Ⅰ～Ⅱ级老年病人80例,年龄60～81岁,均在气管插管全身麻醉下行腹部手术,随机分为两组:LV组:潮气量为7mL/kgPBW;C组:潮气量为12mL/kgPBW,PBW为预测体重。两组通气频率均从12次/min开始调整,使呼气末二氧化碳(PETCO2)保持在正常范围(35～45mmHg)。术毕入恢复室苏醒拔管,记录苏醒评分,拔管时间,低氧等呼吸系统并发症,再插管情况等及恢复室停留时间。结果两组术中BP、SPO2、HR、PETCO2差异无统计学意义(P>0.05)。拔管时间、恢复室停留时间LV组较C组明显缩短(P<0.05),恢复室肺部并发症LV组较C组低氧发生率明显降低(P<0.05)。结论在老年病人全身麻醉中,采用合理的容量限制机械通气策略:保持二氧化碳分压正常范围、适当降低潮气量,维持轻度增快的通气频率,可减少苏醒过程肺部并发症,减少恢复室停留时间。

Effect of Different Ventilation Strategies on Pulmonary Injury in Elder Patients During Surgery under General Anaesthesia

Objective To investigate the effect of two ventilation strategies on lung injury in elder patients during surgery under general anaesthesia. Methods Sixty ASA I or 11 elder patients,Aged 60N81years, scheduled for selective abdominal operation under general anesthesia were divided into two groups randomly： group LV （ VT 7 mL/kg PBW）;group C （VT 12ml/kg PBW）. Pressure controlled ventilation was performed after tracheal intubation, PzrCO2 was maintained at normal range through respiratory rate adjusted （RR）.HR,MAP,SpO2,PETCO2 were monitored continuously and recordedat 5 min（T0） 30 min（T1）,l h（T2）,3 h（T3） after tracheal intubation ;the Steward scores, pulmonary complications and detention time were monitored respectively in recovery room. Results There were no significant differences in HR,MAP.PETCO2 between the two groups （P〉0.05）; extubation time. pulmonary complications and detention time were decrease in recovery room（P〈0.05）. Conclusion Mechanical ventilation （3h） led to Geriatrics Patients lung injury during surgery under general anaesthesia. Low tidal volumes （ PETCO2 at normal range） decreased extubation time, pulmonary complications and detention time in recovery room in Geriatrics patients after surgery under general anaesthesia.