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Bain环路对单肺通气时血气值及肺分流量的影响 总被引:5,自引:0,他引:5
目的与方法:选择22例订前肺功能正常和轻度损害肺地切除术的病人,观察单肺通气(OLV)期间术侧肺加用Bain环路行持续气道正压通气CPAP)对Qs/Qt和氧合的影响。结果与结论:不用Bain环路的1组病人,术侧肺完全萎缩,PaO2、PvO2均明显降低,分别为双肺通气(TLV)时的63%和74%,A-aDO2和Qs/Qt升高,说明低氧血症与OLV时严重肺内分流有关,而在术侧肺加明Bain环路者上述变 相似文献
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异丙酚对单肺通气时肺内分流的影响 总被引:9,自引:0,他引:9
目的:探讨异丙酚对单肺通气(OLV)时缺氧性肺血管收缩(HPV)、肺内分流的影响。方法:观察组用异丙酚6-12mg.kg^-1.h^-1静注,对照组用不抑制HPV、对Qs/Qt无影响的普鲁卡因40-60mg.kg^-1.h^-1静滴。观察两组OLV不同时期Qs/Qt、PaO2、PvO2、PaCo2和PH变化。结果:OLV时两组病人Qs/Qt和PaO2组内不同时值或组间同时值比较均无显著差异。结论: 相似文献
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单肺通气期间提高PETCO2反映PaCO2准确性的研究 总被引:1,自引:0,他引:1
目的:探讨单肺通气期间影响PETCO的因素及如何提高PETCO2反映PaCO2的准确性。方法:对27例患者进行了临床研究。结果:(1)肺内分流(Qs/Qt)量显著影响PETCO2;(2)机械通气参数中,VT对其影响最大,其他依次为RR、FIO2和I/E。结论:单肺通气较合理的参数为VT10ml/kg,RR12次/分,FIO20.8及I/E12。 相似文献
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单肺麻醉期间氟烷和氯胺酮对肺内分流的不同影响 总被引:1,自引:0,他引:1
单肺通气时缺氧性肺血管收缩(HPV)使非通气侧肺内分流减少50%。吸入麻醉药可抑制HPV反应,使Qs/Qt增加,PaO2下降。就氟烷和氯胺酮对HPV和 Qs/Qt的影响,在22例开胸行非肺部手术的成年患者中进行对比观察。结果:两组在OLV2分钟时Qs/Qt明显上升,10分钟时呈下降趋势,但氟烷组Qs/Qt明显高于氯胺酮组,表明氟烷时HPV有抑制作用。PaO2、PaCO2、PvO2、pH等观察指标有相应变化,但尚在正常范围。 相似文献
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异丙酚和安氟醚对单肺通气时肺内分流的影响 总被引:7,自引:0,他引:7
异丙酚是一种新型静脉麻醉药,本文报告异丙酚静脉麻醉和安氟醚吸入麻醉时单肺通气(OLV)条件下对肺内分流(Qs/Qt)的影响。资料与方法病例选择及分组 选择需行OLV的肺、食管手术患者40例,随机分为两组,异丙酚组(Ⅰ组)和安氟醚组(Ⅱ组)各20例。Ⅰ组男13,女7例,年龄(54.14±6.95)岁,体重(56.86±7.8)kg;Ⅱ组男12,女8例,年龄(53.16±7.32)岁,体重(54.40±8.5)kg。两组手术均为肺叶切除和食管癌根治术,肺与食管手术各10例。术前病人无明显心、肺、肝、… 相似文献
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地氟醚与异氟醚吸入对单肺通气肺内分流影响的比较 总被引:2,自引:0,他引:2
缺氧性肺血管收缩(HPV)是肺血流重要的自身调节机制之一[1]。吸入麻醉药对HPV均有不同程度的抑制作用,使单肺通气(OLV)时Q_s/Q_t增加,P_aO_2下降[2]。有文献报道,与氟烷及安氟醚相比,异氟醚抑制最轻[5]。本文以开胸手术需单肺通气的病人进行观察,比较地氟醚和异氟醚相同剂量吸入对单肺通气肺内分流(QS/Qt)的影响及动脉氧分压(PaO_2)降低的程度。探讨两药对单肺通气时HPV的影响。资料与方法无心血管疾病,肺功能基本正常的择期需开胸单肺通气病人20例,ASA为Ⅰ~Ⅱ级,随机分为地… 相似文献
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相同MAC浓度的安氟醚和异氟醚对脑电图功率谱的影响 总被引:4,自引:0,他引:4
24例 20~50岁、ASAⅠ级、行择期外科手术的患者,随机分成两组:安氟醚组和异氟醚组。不用术前药,麻醉诱导以静脉硫喷妥钠5mg/kg、阿曲库胺0.6~0.7mg/kg。单纯吸入安氟醚或异氟醚维持全麻。气管插管后控制呼吸,维持呼气末二氧化碳分压(PETCO2)4.27。4.93hpa。以TOF监测肌松,间断给予阿曲库胺 10~15mg,维持T4/T1<25%。采用 FP1-A1、FP2-A2双导联监护脑电,验证呼气末麻醉药浓度在 0. 5、0.8、1. 0、1. 3和 1.5 MAC时的脑电功率谱、95%边缘频率(SEF)和中心频率(MPF)改变。结果发现,随MAC增加脑电功率谱表现出波增加,α和β波减少,而SEF、MPF值随MAC增加而减少的改变呈负性线性关系,r=-0.95。提示脑电功率谱、SEF和MPF在评价全麻深度上有一定意义。 相似文献
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Prevention of atelectasis formation during the induction of general anesthesia in morbidly obese patients 总被引:6,自引:0,他引:6
Coussa M Proietti S Schnyder P Frascarolo P Suter M Spahn DR Magnusson L 《Anesthesia and analgesia》2004,98(5):1491-5, table of contents
Atelectasis caused by general anesthesia is increased in morbidly obese patients. We have shown that application of positive end-expiratory pressure (PEEP) during the induction of anesthesia prevents atelectasis formation in nonobese patients. We therefore studied the efficacy of PEEP in morbidly obese patients to prevent atelectasis. Twenty-three adult morbidly obese patients (body mass index >35 kg/m(2)) were randomly assigned to one of two groups. In the PEEP group, patients breathed 100% oxygen (5 min) with a continuous positive airway pressure of 10 cm H(2)O and, after the induction, mechanical ventilation via a face mask with a PEEP of 10 cm H(2)O. In the control group, the same induction was applied but without continuous positive airway pressure or PEEP. Atelectasis, determined by computed tomography, and blood gas analysis were measured twice: before the induction and directly after intubation. After endotracheal intubation, patients of the control group showed an increase in the amount of atelectasis, which was much larger than in the PEEP group (10.4% +/- 4.8% in control group versus 1.7% +/- 1.3% in PEEP group; P < 0.001). After intubation with a fraction of inspired oxygen of 1.0, PaO(2) was significantly higher in the PEEP group compared with the control group (457 +/- 130 mm Hg versus 315 +/- 100 mm Hg, respectively; P = 0.035) We conclude that in morbidly obese patients, atelectasis formation is largely prevented by PEEP applied during the anesthetic induction and is associated with a better oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during induction of general anesthesia in morbidly obese patients prevents atelectasis formation and improves oxygenation. Therefore, this technique should be considered for anesthesia induction in morbidly obese patients. 相似文献
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Rusca M Proietti S Schnyder P Frascarolo P Hedenstierna G Spahn DR Magnusson L 《Anesthesia and analgesia》2003,97(6):1835-1839
General anesthesia promotes atelectasis formation, which is augmented by administration of large oxygen concentrations. We studied the efficacy of positive end-expiratory pressure (PEEP) application during the induction of general anesthesia (fraction of inspired oxygen [FIO(2)] 1.0) to prevent atelectasis. Sixteen adult patients were randomly assigned to one of two groups. Both groups breathed 100% O(2) for 5 min and, after a general anesthesia induction, mechanical ventilation via a face mask with a FIO(2) of 1.0 for another 5 min before endotracheal intubation. Patients in the first group (PEEP group) had continuous positive airway pressure (CPAP) (6 cm H(2)O) and mechanical ventilation via a face mask with a PEEP of 6 cm H(2)O. No CPAP or PEEP was applied in the control group. Atelectasis, determined by computed radiograph tomography, and analysis of blood gases were measured twice: before the beginning of anesthesia and directly after the intubation. There was no difference between groups before the anesthesia induction. After endotracheal intubation, patients in the control group showed an increase of the mean area of atelectasis from 0.8% +/- 0.9% to 4.1% +/- 2.0% (P = 0.0002), whereas the patients of the PEEP group showed no change (0.5% +/- 0.6% versus 0.4% +/- 0.7%). After the intubation with a FIO(2) of 1.0, PaO(2) was significantly higher in the PEEP group than in the control (591 +/- 54 mm Hg versus 457 +/- 99 mm Hg; P = 0.005). Atelectasis formation is prevented by application of PEEP during the anesthesia induction despite the use of large oxygen concentrations, resulting in improved oxygenation. IMPLICATIONS: Application of positive end-expiratory pressure during the induction of general anesthesia prevents atelectasis formation. Furthermore, it improves oxygenation and probably increases the margin of safety before intubation. Therefore, this technique should be considered for all anesthesia induction, at least in patients at risk of difficult airway management during the anesthesia induction. 相似文献
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BACKGROUND/PURPOSE: Postoperative nausea and vomiting is common after general anesthesia. The timing of resuming oral input is arbitrary. This study aims to estimate the duration of emetic effects of general anesthesia after day surgery in children with electrogastrography (EGG). METHODS: Children between the age of 3 and 12 years undergoing elective nonabdominal surgery were recruited. The standard anesthesia protocol of thiopentone (5 mg/kg), O2 (30%), N2O (70%), and isoflurane (1.5%) was adopted. Caudal block was applied to the patients. A laryngeal mask was used. A mobile electrogastrogram (EGG) machine (Synectic; International Medtronic Synectics, Stockholm, Sweden) was attached to the epigastrium of the patient at least 1 hour before the operation and the recording continued through the operation and for a further 2 hours after the operation. The first half hour of preoperative recording was taken as normal control period. The results were analyzed using paired t test. RESULTS: Twenty patients who underwent circumcision under general anesthesia were studied. The mean age was 6.6 years. The mean anesthetic duration was 33.2 min. The tachygastria component (associated with nausea and vomiting) became prominent immediately after induction and returned to normal 1 half hour after cessation of general anesthesia. The dominant frequency instability coefficient of EGG (DFIC) and the dominant power instability coefficient (DPIC) peaked during the first half hour period postoperatively and returned to baseline 1 hour postoperatively (DPIC, P>.05). Bradygastria became prominent during the periods 1 half-hour before and 1 half-hour after the general anesthesia and returned to baseline 1 hour postoperatively (P<.05). CONCLUSIONS: Significant EGG changes occur during day-surgery general anesthesia for children undergoing nonabdominal surgery. These changes return to baseline 1 hour after reversal of anesthesia. It is probably safe to restart feeding 1 hour later after day-surgery general anesthesia without causing nausea and vomiting. 相似文献
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Inoue K 《Masui. The Japanese journal of anesthesiology》2004,53(6):622-628
BACKGROUND: Respiratory failure after cardiopulmonary bypass (CPB) remains one of the major complications after cardiac surgery. This study was designed to evaluate effects of respiratory care after CPB on pulmonary function. METHODS: Eighteen patients scheduled for cardiac surgery were investigated. Preoperative respiratory functions (%VC, FEV1.0%, V25/Ht, FRC-CC, deltaN2) were measured in all the patients. Both induction and maintenance of anesthesia were performed using propofol, midazolam, fentanyl, and vecuronium bromide. All the patients were ventilated using volume controlled ventilation by setting FIO2 at 0.5, the respiratory frequency at 15 x min(-1), the tidal volume at 6-10 ml x kg(-1) adjusted to maintain PaCO2 between 30 to 40 mmHg, and the peak airway pressures below 40 cmH2O, PEEP of 0 cmH2O. From 1 hour after the operation, the patients were randomly divided into 2 groups: group A, ventilated artificially with PEEP of 5 cmH2O and group B, ventilated with PEEP adjusted to the patient's lower inflection point (LIP) obtained by the pressure-volume curve. PaO2, Qs/Qt and FRC were measured after induction of anesthesia, just after surgery, 1 hour after surgery and 1 hour after artificial ventilation with PEEP. The values of the LIP were obtained from the P-V curves with the constant-flow methods before and after surgery. RESULTS: PaO2 and FRC decreased and Qs/Qt increased significantly after the surgery in all the patients. One hour after artificial ventilation with PEEP, PaO2 increased and Qs/Qt decreased significantly compared with the values after operation. However, there was no significant difference in the magnitude of these changes among the different groups. The changes in PaO2 and Qs/Qt were not correlated with the changes in FRC and preoperative respiratory functions. The LIP tended to increase after surgery in 2 groups. CONCLUSIONS: Although pulmonary function deteriorated after CPB. PEEP could improve oxygenation in all the patients. There were no significant differences in the degree of these improvements between patients receiving PEEP of 5 cmH2O and patients with PEEP adjusted to their LIP. There was no significant relationship between preoperative pulmonary function and changes in oxygenation after CPB. 相似文献
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Positive end-expiratory pressure during induction of general anesthesia increases duration of nonhypoxic apnea in morbidly obese patients 总被引:5,自引:0,他引:5
Positive end-expiratory pressure (PEEP) applied during induction of anesthesia prevents atelectasis formation and increases the duration of nonhypoxic apnea in nonobese patients. PEEP also prevents atelectasis formation in morbidly obese patients. Because morbidly obese patients have difficult airway management more often and because arterial desaturation develops rapidly, we studied the clinical benefit of PEEP applied during anesthesia induction. Thirty morbidly obese patients were randomly allocated to one of two groups. In the PEEP group, patients breathed 100% O(2) through a continuous positive airway pressure device (10 cm H(2)O) for 5 min. After induction of anesthesia, they were mechanically ventilated with PEEP (10 cm H(2)O) for another 5 min until tracheal intubation. In the control group, the sequence was the same but without any continuous positive airway pressure or PEEP. We measured apnea duration until Spo(2) reached 90% and we performed arterial blood gases analyses just before apnea and at 92% Spo(2). Nonhypoxic apnea duration was longer in the PEEP group compared with the control group (188 +/- 46 versus 127 +/- 43 s; P = 0.002). Pao(2) was higher before apnea in the PEEP group (P = 0.038). Application of positive airway pressure during induction of general anesthesia in morbidly obese patients increases nonhypoxic apnea duration by 50%. 相似文献
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Intraoperative phenylephrine infusion decreases the magnitude of redistribution hypothermia. 总被引:3,自引:0,他引:3
Core hypothermia during the first hour after induction of general anesthesia results largely from an internal core-to-peripheral redistribution of body heat. This redistribution results from both central inhibition of tonic thermoregulatory vasoconstriction in the arteriovenous shunt and anesthetic-induced vasodilation. We therefore tested the hypothesis that acute administration of phenylephrine, a pure alpha-adrenergic agonist, reduces the magnitude of anesthetic-induced core-to-peripheral redistribution of body heat. Patients undergoing minor oral surgery were randomly assigned to an infusion of 0.5 microgram.kg-1.min-1 phenylephrine i.v. or no treatment (control). The phenylephrine infusion was started immediately before anesthesia was induced with 2.5 mg/kg propofol i.v. Subsequently, anesthesia was maintained with sevoflurane and 60% nitrous oxide in oxygen. Calf minus toe, skin-temperature gradients < 0 degree C were considered indicative of significant arteriovenous shunt vasodilation. Ambient temperature and end-tidal concentrations of maintenance sevoflurane were comparable in each group. Although there were no significant differences in skin-temperature gradients, core temperatures in the untreated patients decreased significantly more (1.2 +/- 0.4 degrees C) than in those given phenylephrine (0.5 +/- 0.2 degree C, P < 0.001). These data suggest that maintaining precapillary vasoconstriction of blood vessels, not in the arteriovenous shunt reduces the magnitude of redistribution hypothermia. Implications: Core hypothermia immediately after induction of general anesthesia results largely from core-to-peripheral redistribution of body heat. Core temperature reduction during the first hour of anesthesia decreased less in patients given phenylephrine than in untreated controls. These data suggest that maintaining precapillary vasoconstriction possibly reduces the magnitude of redistribution hypothermia. 相似文献
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C. Klingstedt G. Hedenstierna S. Baehrendtz H. Lundqvist Å. Strandberg L. Tokics B. Brismar 《Acta anaesthesiologica Scandinavica》1990,34(6):421-429
Patients without respiratory symptoms were studied awake and during general anesthesia with mechanical ventilation prior to elective surgery. Ventilation-perfusion (VA/Q) relationships, gas exchange and atelectasis formation were studied during five different conditions: 1) supine, awake; 2) supine during anesthesia with conventional mechanical ventilation (CV); 3) in the left lateral position during CV; 4) as 3) but with 10 cm of positive end-expiratory pressure (PEEP) and 5) as 3) but using differential ventilation with selective PEEP (DV + SPEEP) to the dependent lung. Atelectatic areas and increases of shunt blood flow and blood flow to regions with low VA/Q ratios appeared after induction of anesthesia and CV. With the patients in the lateral position, further VA/Q mismatch with a fall in PaO2 and increased dead space ventilation was observed. Atelectatic lung areas were still present, although the total atelectatic area was slightly decreased. Some of the effects caused by the lateral position could be counteracted by adding PEEP. Perfusion of regions with low VA/Q ratios and venous admixture were then diminished, while PaO2 was slightly increased; shunt blood flow and dead space ventilation were essentially unchanged. During CV + PEEP, there was a decrease in cardiac output, compared to CV in the lateral position. DV + SPEEP was more effective than CV + PEEP in decreasing shunt flow and increasing PaO2 in the lateral position; in addition to this, cardiac output was not affected. 相似文献
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目的探讨从麻醉诱导期开始采用肺保护性通气策略对妇科腔镜手术患者氧合及预后的影响。方法选择在本院接受妇科腹腔镜手术的患者60例,随机分为三组,每组20例。采用间歇正压通气(IPPV)模式,氧浓度为100%,氧气流量2 L/min,吸呼比为1∶2。A组:从诱导期(即自主呼吸消失后,予面罩机械通气5 min)开始全程通气模式:VT6 ml/kg,RR 16次/分,PEEP为5cm H2O,每30分钟给予一次手法肺复张(手控通气,气道压力维持40 cm H2O,持续30 s);B组:诱导期通气模式:VT10 ml/kg,RR 10次/分,插管后通气模式:VT6 ml/kg,RR 16次/分,PEEP 5cm H2O,每30分钟给予一次手法肺复张;C组:全程通气模式均为VT10 ml/kg,RR 10次/分。记录插管前(T0)、气腹后(T1)、手术开始30 min(T2)、60 min(T3)、放气腹(T4)时的气道峰压(Ppeak)、平均气道压(Pmean)、计算肺顺应性(CL),并在T0、T1、T3、清醒拔管后吸空气5 min(T5)时抽取动脉血进行血气分析,计算氧合指数(OI)及肺内分流率(Qs/Qt)。记录患者术后并发症发生情况与住院天数。结果与T0时比较,T1~T4时三组Ppeak和Pmean均明显升高,C组Ppeak明显高于A组和B组(P0.05),T2时C组Pmean明显高于A组和B组(P0.05);三组CL在气腹后明显降低(P0.05),T3和T4时C组明显低于A组和B组(P0.05);三组PETCO2在气腹后明显升高,T2~T4时C组明显低于A组与B组(P0.05),A组与B组差异无统计学意义;三组OI随着时间延长变化差异无统计学意义,拔管后三组均明显降低(P0.05);三组Qs/Qt随着手术进行呈上升趋势,与T0时比较,三组在T3时明显上升(P0.05),C组明显大于A组和B组(P0.05);T5时均明显下降(P0.05)。术后仅C组有1例发生肺部感染。结论与常规通气相比,对接受妇科腔镜手术患者采用保护性肺通气策略能够明显改善患者的肺顺应性和氧合功能,有利于肺保护。 相似文献
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Yamamoto Y Ohki K Matsukawa T Gohara T Oshibuchi T 《Masui. The Japanese journal of anesthesiology》2001,50(7):747-751
General anesthesia inhibits thermoregulation by suppressing tonic vasoconstriction and facilitates a core-to-peripheral redistribution of body heat, which is the major cause of core hypothermia during the first hour of anesthesia. We randomly assigned 16 patients to two groups; 1) patients who received fentanyl (1 microgram.kg-1, i.v.) and propofol (1.5 mg.kg-1.h-1) during insertion of epidural catheters (P group), and 2) no drug (control) group (C group). We measured tympanic (Ttym) and skin temperatures at the time of admission to operating rooms, after dural catheter insertion, before induction of anesthesia, just after induction of anesthesia, and one hour after induction. After dural catheter insertion, forearm-finger tip skin temperature gradient of P group was significantly smaller than C group. One hour after induction of anesthesia, Ttym of P group was significantly higher than C group. We can conclude that a sedative dose of propofol and fentanyl before induction of general anesthesia inhibits redistribution hypothermia during general anesthesia. 相似文献