低潮气量通气对老年腹部手术肺顺应性及氧合的影响

目的研究低潮气量通气对老年人术巾肺顺应性（CL）及氧合的影响。方法40例60岁以上、ASAI或Ⅱ级老年患者，在气管插管全身麻醉下实施择期开腹手术。观察组潮气量（VT）为7ml／kg预测体质量（PBW）；对照组VT为12ml／kgPBW。分别于插管后5min（T0）、30min（T1）、1h（T2）、3h（T3）4个时点记录心率（HR）、平均动脉压（MAP）、血氧饱和度（SpO2）、呼气末二氧化碳分压（PETCO2）、气道峰压（Ppeak）、气道平台压（Pplat）、CL；并于各时点桡动脉处抽血测血气指标。结果对照组在机械通气期间，Ppeak、Pplat明显高于观察组（P=0．012，P=0．013）；两组CL均随着时间延长呈下降趋势，对照组低于观察组（P=0．012）；对照组T3时点PaO2低于观察组（P〈0．05）。结论低潮气量通气改善了老年人术中的氧合及CL，能减轻机械通气造成的肺损伤。

Effect of low tidal volumes on lung compliance and oxygenation in elder patients during abdominal surgery

Objective To investigate the effect of low tidal volumes on lung compliance （CL） and oxygenation in eld- er patients during abdominal surgery. Methods Forty ASA I or II elder patients, aged over 60 years, scheduled for se- lective abdominal operation under general anesthesia were divided randomly into 2 groups ： group LV （ VT 7 ml/kg PBW） and group C （VT 12 ml/kg PBW）. HR, MAP, SpO2, PETCO2 , Ppeak, Pplat, CL were monitored continuously and recor- ded at 5 min （T0 ）, 30 min （T1 ）, 1 h （T2）, 3 h （ T3 ） after tracheal intubation. Arterial blood gas analysis was performed at the same point. Result Compared with the group C, mechanical ventilation with low tidal volumes had lower peak air- way pressures （Pplat and Ppeak, respectively）, and higher CL and PaO2. Conclusions Mechanical ventilation with low tidal volumes can improve CL and PaO2 in eider patients with abdominal surgery, which alleviates their abdominal injury.