摘要
目的评价间歇通气呼吸暂停麻醉法联合低水平PEEP机械通气对老年输尿管软镜手术患者的影响。方法选择气管内插管全麻下输尿管软镜手术老年患者30例。采用间歇通气呼吸麻醉法联合低水平PEEP(5cm H2O)机械通气,VT10ml/kg,RR 12次/分,呼吸暂停时间为2min,呼吸暂停次数为5次。观察记录患者麻醉前(T1)、手术开始前(T2)、第1次(T3)、2次(T4)、3次(T5)、4次(T6)、5次呼吸暂停2min后(T7)、手术结束后15min(T8)、拔管后60min(T9)的HR、BP、pH、PaCO2、PaO2;记录T1、T9的肺泡-动脉氧分压差(A-aDO2)并计算呼吸指数(RI)。结果 T1、T9时的A-aDO2、RI差异无统计学意义;与T1、T2和T8时比较,患者T3～T7时pH值明显下降(P<0.05);PaCO2明显升高(P<0.05),T8时均恢复至正常水平;与T1、T2和T8时比较,T3～T7时PaO2明显下降(P<0.05),但最低值>356mm Hg。结论间歇通气呼吸暂停麻醉法联合小潮气量加低水平PEEP机械通气可安全、有效地应用于老年输尿管软镜手术。
Objective To investigate the influences of intermittent ventilation combined with low level PEEP in geriatric holmium laser lithoclasty with flexible ureteroscope on respiratory and circulatory function.Methods Thirty elderly patients undergoing holmium laser lithoclasty with flexible ureteroscope enrolled.Ventilator parameter set up as：VT10ml/kg,RR 12/min,ventilator off period 2min/each,and ventilator was off for 5times totally during operation.HR,MBP,pH,PaCO2,PaO2 and calculated respiratory index（RI）at pre-anesthesia（T1）,pre-operation（T2）,end of the first apnea（T3）,end of the second apnea（T4）,end of the third apnea（T5）,end of the fourth apnea（T6）,end of the fifth apnea（T7）and 15 minutes after operation（T8）,60 min after tracheal extubation（T9）were recorded.A-aDO2 and RI were recorded at T1 and T9.Results There were no satistically significant differences of A-aDO2,RI at T1,T9.The pH value were lower at T3-T7 compared with at T1 and T2（P〈0.05）.The PaCO2 were higher at T3-T7 compared with at T1,T2 and T8（P〈0.05）,and returned to normal at T8.The PaO2 were lower at T3-T7 compared with at T1,T2 and T8（P〈0.05）,though the lowest value still higher than 356 mm Hg.Conclusion Anesthesia with intermittent ventilation combined with low level PEEP can be applied safely during geriatric holmium laser lithoclasty with flexible ureteroscope.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2014年第9期880-882,共3页
Journal of Clinical Anesthesiology
基金
长沙市科学技术局2012年科技计划项目(No:K12ZD011-33)
关键词
呼吸暂停
输尿管软镜
钬激光碎石术
Apneic
Flexible ureteroscope
Holmium laser lithoclasty
